Immunotherapy and Radiotherapy for Older Cancer Patients during the COVID-19 Era: Proposed Paradigm by the International Geriatric Radiotherapy Group

Background: Older cancer patients with locally advanced or metastatic disease may benefit from chemotherapy alone or combined with radiotherapy. However, chemotherapy is often omitted either because of physician bias or because of its underlying comorbidity, thus compromising their survival. The coronavirus disease 19 (COVID-19) pandemic is compounding this issue because of the fear of immunosuppression induced by chemotherapy on the elderly which makes them more vulnerable to the virus. Summary: Immunotherapy has less effect on the patient bone marrow compared to chemotherapy. The potential synergy between radiotherapy and immunotherapy may improve local control and survival for older patients with selected cancer. Preliminary data are encouraging because of better survival and local control in diseases which are traditionally resistant to radiotherapy and chemotherapy such as melanoma and renal cell carcinoma. Key Message: We propose a new paradigm combining immunotherapy at a reduced dose and/or extended dosing intervals and hypofractionated radiotherapy for older patients with selected cancer which needs to be tested in future clinical trials.

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Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group

Cancers ◽

10.3390/cancers11030371 ◽

2019 ◽

Vol 11 (3) ◽

pp. 371 ◽

Cited By ~ 5

Author(s):

Tiberiu Popescu ◽

Ulf Karlsson ◽

Vincent Vinh-Hung ◽

Lurdes Trigo ◽

Juliette Thariat ◽

...

Keyword(s):

Cancer Patients ◽

Systemic Therapy ◽

Combined Therapy ◽

Locally Advanced ◽

Future Research ◽

Stereotactic Techniques ◽

Radiotherapy Group ◽

Radiation Oncologists ◽

Older Cancer Patients ◽

Cancer Specialists

The management of older cancer patients remains difficult because of data paucity. Radiation oncologists need to identify potential issues which could affect treatment of those patients. A workshop was organized in Barcelona among international radiation oncologists with special interest in the management of older cancer patients on April 22, 2018. The following consensus was reached: 1. Older cancer patients often faced unconscious discriminating bias from cancer specialists and institutions because of their chronological age. 2. Advances in radiotherapy techniques have allowed patients with multiple co-morbidities precluding surgery or systemic therapy to achieve potential cure in early disease stages. 3. The lack of biomarkers for frailty remains an impediment to future research. 4. Access to healthcare insurance and daily transportation remains an issue in many countries; 5. Hypofractionation, brachytherapy, or stereotactic techniques may be ideally suited for older cancer patients to minimize transportation issues and to improve tolerance to radiotherapy. 6. Patients with locally advanced disease who are mentally and physically fit should receive combined therapy for potential cure. 7. The role of systemic therapy alone or combined with radiotherapy for frail patients needs to be defined in future clinical trials because of targeted agents or immunotherapy may be less toxic compared to conventional chemotherapy.

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Should Older Cancer Patients be Tested for Coronavirus-19 Disease Before Treatment: Recommendation of the International Geriatric Radiotherapy Group

Gerontology & Geriatrics Studies ◽

10.31031/ggs.2020.06.000641 ◽

2020 ◽

Vol 6 (4) ◽

Author(s):

Nam P Nguyen

Keyword(s):

Cancer Patients ◽

Treatment Recommendation ◽

Radiotherapy Group ◽

Older Cancer Patients

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Cancer in the older person

Reviews in Clinical Gerontology ◽

10.1017/s0959259809002913 ◽

2008 ◽

Vol 18 (4) ◽

pp. 313-321

Author(s):

Peter Stephens

Keyword(s):

Cancer Patients ◽

Clinical Oncology ◽

Older Patients ◽

Malignant Disease ◽

Task Force ◽

Annual Conference ◽

Older Person ◽

European Organisation ◽

Older Cancer Patients ◽

American Society

The challenges of treating malignant disease in the older population are gaining greater prominence. In the last 10 years the European Organisation for Research and Treatment of Cancer (EORTC) has established a task force to examine challenges of managing older cancer patients. As an indication of their importance, the American Society of Clinical Oncology (ASCO) specifically addressed the issues raised by older patients at their annual conference in 2004.

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Preoperative Inflammatory Markers as a Predictor of Three-Year Overall Survival in Older Cancer Patients Undergoing Oncologic Surgery

Cancers ◽

10.3390/cancers13081824 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1824

Author(s):

Baukje Brattinga ◽

Abraham Rutgers ◽

Jacco J. De Haan ◽

Anthony R. Absalom ◽

Hanneke van der Wal-Huisman ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factor ◽

Plasma Level ◽

Cancer Patients ◽

Inflammatory Markers ◽

Older Patients ◽

Specific Group ◽

Oncologic Surgery ◽

Older Cancer Patients ◽

Multivariate Hazard Ratio

Oncologic surgery results in substantially higher morbidity and mortality rates in older patients compared to younger patients, yet little is known about the relation between the preoperative inflammatory state and postoperative outcome in the specific group of older cancer patients. The aim of this study was to examine whether preoperative inflammatory markers could be a predictor of overall survival in older patients undergoing elective surgery for a solid malignant tumor. Patients 65 years and older undergoing surgery for a solid malignant tumor were included in a prospective cohort study. Inflammatory markers C-reactive protein (CRP), interleukin-1 beta (IL-1β), IL-6, IL10, IL-12 and tumor necrosis factor-alpha (TNF-α) were measured in plasma samples preoperatively. The main outcome was overall survival three years after surgery. Between 2010 and 2016, 328 patients with a median age of 71.5 years (range 65–89) were included. A significantly higher mortality rate three years after surgery, was found in patients with high preoperative plasma levels of CRP and IL-6 (p = 0.013 and p = 0.046, respectively). In multivariate analysis, corrected for variables such as age, disease stage, frailty, comorbidities, type of surgery and complications, a preoperative plasma level of CRP ≥ 10 mg/L was an independent prognostic factor for inferior overall survival three years after surgery (multivariate hazard ratio 1.50, 95% confidence interval 1.04–2.16, p = 0.031). Also, for the specific group of patients with colorectal cancer, a preoperative plasma level of CRP ≥ 10 mg/L was a prognostic factor for inferior survival three years after surgery (multivariate hazard ratio 2.40, 95% confidence interval 1.20–4.81, p = 0.014). Preoperative elevated plasma level of CRP is an independent unfavorable prognostic factor for overall survival three years after oncologic surgery. This gives more insight into the relationship between inflammation and survival in older cancer patients, and might contribute to risk stratification for poor outcome after surgery in older cancer patients.

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Faculty Opinions recommendation of Challenges facing radiation oncologists in the management of older cancer patients: consensus of the international geriatric radiotherapy group.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735359650.793573983 ◽

2020 ◽

Author(s):

Lorenzo Livi ◽

Isacco Desideri

Keyword(s):

Cancer Patients ◽

Radiotherapy Group ◽

Radiation Oncologists ◽

Older Cancer Patients

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Radiation induced toxicity in rectal cancer patients

Acta chirurgica iugoslavica ◽

10.2298/aci1601033s ◽

2016 ◽

Vol 63 (1) ◽

pp. 33-41 ◽

Cited By ~ 1

Author(s):

Suzana Stojanovic-Rundic ◽

Vesna Plesinac-Karapandzic ◽

Aleksandar Rankovic ◽

Katarina Obradovic ◽

Marko Dozic ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Local Control ◽

Locally Advanced ◽

Intensity Modulated Radiation Therapy ◽

Disease Free Survival ◽

Conformal Radiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Radiation Toxicity

Preoperative radiotherapy ? chemotherapy became the standard treatment for locally advanced rectal cancer. Despite better local control with this approach, there was not seen a significant improvement in overall survival and disease free survival, yet. The main disadvantage is toxicity that can be developed, especially concomitantly with chemotherapy. Toxicity can be acute and late. Acute complications are transitory, but late might lead to permanent damage and consequently are more significant for patients. Today, there are technical opportunities in reduction of acute and late radiation toxicity in the treatment of rectal cancer. With the implementation of 3D conformal radiotherapy (3D CRT) and intensity modulated radiation therapy (IMRT) techniques in clinical practice significant accuracy, better dose distribution and safety in the treatment of rectal cancer patients is achieved, with maximal sparing of surrounding normal tissue. Utilization of advanced techniques and new software solutions can keep adverse effects on satisfactory levels with excellent local control.

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Recent advances in cancer surgery in older patients

F1000Research ◽

10.12688/f1000research.10683.1 ◽

2017 ◽

Vol 6 ◽

pp. 1242 ◽

Cited By ~ 5

Author(s):

Siri Rostoft ◽

Riccardo A. Audisio

Keyword(s):

Cancer Patients ◽

Older Patients ◽

Postoperative Morbidity ◽

Gynecological Cancer ◽

Functional Limitations ◽

Preoperative Evaluation ◽

Cognitive Status ◽

Frailty Assessment ◽

Older Cancer Patients

Age is the most important risk factor for the occurrence of cancer, and a declining mortality from heart disease and other non-cancer causes leaves an older population that is at high risk of developing cancer. Choosing the optimal treatment for older cancer patients may be a challenge. Firstly, older age and associated factors such as comorbidities, functional limitations, and cognitive impairment are risk factors for adverse effects of cancer treatment. Secondly, older patients are often excluded from clinical trials, and current clinical guidelines rarely address how to manage cancer in patients who have comorbidities or functional limitations. The importance of incorporating frailty assessment into the preoperative evaluation of older surgical patients has received increasing attention over the last 10 years. Furthermore, studies that include endpoints such as functional status, cognitive status, and quality of life beyond the standard endpoints, i.e. postoperative morbidity and mortality, are starting to emerge. This review looks at recent evidence regarding geriatric assessment and frailty in older surgical cancer patients and provides a summary of newer studies in colorectal, liver, pancreatic, and gynecological cancer and renal and central nervous system tumors.

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