scholarly journals Clinical Outcomes of Radiotherapy in Elderly and Younger Patients with T4 Esophageal Cancer: A Retrospective Single-Center Analysis

2021 ◽  
Author(s):  
Yosuke Takakusagi ◽  
Kio Kano ◽  
Satoshi Shima ◽  
Keisuke Tsuchida ◽  
Nobutaka Mizoguchi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Outcomes ◽  
Complete Response ◽  
The Elderly ◽  
Elderly Group ◽  
Cancer Center ◽  
Esophageal Fistula ◽  
Younger Patients ◽  
Significant Difference ◽  
T4 Esophageal Cancer

Abstract Background/AimThe standard of treatment for esophageal cancer with adjacent organ invasion (T4) has not been established. Radiotherapy (RT) is a treatment option, but its efficacy and safety in elderly patients remains unclear. We retrospectively analyzed the clinical outcomes of RT in elderly and younger patients with T4 esophageal cancer.Materials and MethodsSixty-nine patients with T4 esophageal cancer who underwent RT at the Kanagawa Cancer Center between January 2014 and November 2020 were included in this study. Patients aged ≥70 years were defined as the elderly group and those aged <70 years were defined as the younger group.The total dose of RT was set at 60 Gy in 30 fractions. Chemotherapy combined with 5-fluorouracil and cisplatin was administered concurrently with RT. The overall survival (OS) rate was estimated using the Kaplan–Meier method. Adverse events were assessed using the CTCAE v4.0. Clinical outcomes were compared between the elderly and younger groups.ResultsThe median survival time (MST) of the elderly group was 21.5 months, and the OS rates at 1, 3, and 5 years were 63.7%, 31.3%, and 15.6%, respectively. The MST of the younger group was 12.5 months, and the OS rates at 1, 3, and 5 years were 52.2%, 29.4%, and 29.4%, respectively. A significant difference in OS was not observed between the two groups (p = 0.767). Themultivariate analysis revealed thatthe complete response (CR) of the primary tumor and adjuvant chemotherapy (ACTx) were significant predictors of OS (p< 0.001 and<0.001, respectively). Regarding toxicity, the frequency of thrombocytopenia was significantly higher in the elderly group, whereas the frequency of esophageal fistula was significantly higher in the younger group (p = 0.012 and 0.022, respectively). Other toxicities were not significantly different between the two groups.ConclusionsOS was not significantly different between the elderly and younger groups. ACTx and CR were predictors of OS. The frequency of thrombocytopenia was higher in the elderly group and that of esophageal fistula was higher in the younger group. However, other toxicities were not significantly differentbetween the two groups.

scholarly journals Outcomes of endoscopic submucosal dissection for superficial esophageal cancer in an elderly population: a retrospective single center cohort study

2019 ◽  
Vol 07 (03) ◽  
pp. E355-E360 ◽  
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Shu Hoteya
Keyword(s):  
Esophageal Cancer ◽  
Elderly Patients ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Superficial Esophageal Cancer ◽  
Younger Patients ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is increasingly being used to treat superficial esophageal cancer in the elderly. However, data on clinical outcomes in this age group are limited. The aim of this study was to evaluate the safety and efficacy of ESD in treatment of superficial esophageal cancer and its effect on long-term outcome in the elderly. Patients and methods In total, 664 consecutive patients with a histological diagnosis of squamous cell carcinoma or high-grade intraepithelial neoplasia who underwent ESD between April 2008 and March 2016 at our institution were enrolled. Clinical outcomes and prognostic factors were compared retrospectively between those aged 75 years or older (n = 162) and those aged younger than 75 years (n = 502). Results There was no significant difference in post-ESD bleeding (0 vs. 0.8 %, P = 0.27) and perforation rates (1.8 vs. 1.2 %, P = 0.47) between the two age groups; however, stricture rate was higher in younger patients than in elderly patients (20.8 % vs 11 %; P = 0.036). There was no significant difference in the rate of locoregional recurrence between the two groups. Overall survival was significantly different between the two groups, but cause-specific survival was similar. Conclusion These findings confirm the efficacy of ESD for superficial esophageal cancer in selected elderly patients (75 years or older) who were fit for the treatment because they can achieve similar long-term survival to younger patients.

Hemifacial Spasm: Comparison of Results between Patients Older and Younger than 70 Years Operated on with Microvascular Decompression

2021 ◽  
Author(s):  
Hua Zhao ◽  
Jin Zhu ◽  
Yin-da Tang ◽  
Lin Shen ◽  
Shi-ting Li
Keyword(s):  
Elderly Patients ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
Facial Palsy ◽  
The Elderly ◽  
Elderly Group ◽  
Effective Treatment Option ◽  
Younger Patients ◽  
Significant Difference ◽  
Csf Leakage

Abstract Objective The aim of the present study was to evaluate the efficacy and safety of microvascular decompression (MVD) for primary hemifacial spasm (HFS) in patients aged ≥70 years and to compare the outcome with a control cohort of younger patients(<70 years). Methods In this retrospective study, subjects were divided into two groups: an elderly group (patients who were ≥70 years) and a younger group. We compared demographic and clinical data, surgical outcome, MVD-related complications, and duration of operation and hospitalization after MVD between the two groups. Results At a mean follow-up of 32 ± 4.2 months, 188 elderly patients (90.4%) reported an effective outcome without need for any medication versus 379 (91.1%) of the younger cohort. There was no mortality in both cohorts. The prevalence of delayed facial palsy was 4.8% in the elderly group and 4.1% in the younger group. One (0.5%) patient in the elderly group and 3 (0.7%) patients in the younger group suffered cerebrospinal fluid (CSF) leakage. There was no significant difference between the two groups in terms of MVD-related complications, such as delayed facial palsy, hearing impairment, CSF leakage, and hematoma. Conclusions MVD is an effective treatment option in elderly patients with HFS as well as in younger patients. Age itself seems to be no relevant contraindication or, alternatively, risk factor regarding MVD.

Endoscopic endonasal transsphenoidal surgery in elderly patients with pituitary adenomas

2015 ◽  
Vol 123 (1) ◽  
pp. 31-38 ◽  
Author(s):  
Jackson A. Gondim ◽  
João Paulo Almeida ◽  
Lucas Alverne F. de Albuquerque ◽  
Erika Gomes ◽  
Michele Schops ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Transsphenoidal Surgery ◽  
Clinical Status ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Endoscopic Transsphenoidal Surgery ◽  
Younger Patients ◽  
Significant Difference

OBJECT With the increase in the average life expectancy, medical care of elderly patients with symptomatic pituitary adenoma (PA) will continue to grow. Little information exists in the literature about the surgical treatment of these patients. The aim of this study was to present the results of a single pituitary center in the surgical treatment of PAs in patients > 70 years of age. METHODS In this retrospective study, 55 consecutive elderly patients (age ≥ 70 years) with nonfunctioning PAs underwent endoscopic transsphenoidal surgery at the General Hospital of Fortaleza, Brazil, between May 2000 and December 2012. The clinical and radiological results in this group were compared with 2 groups of younger patients: < 60 years (n = 289) and 60–69 years old (n = 30). RESULTS Fifty-five patients ≥ 70 years of age (average age 72.5 years, range 70–84 years) underwent endoscopic surgery for treatment of PAs. The mean follow-up period was 50 months (range 12–144 months). The most common symptoms were visual impairment in 38 (69%) patients, headache in 16 (29%) patients, and complete ophthalmoplegia in 6 (10.9%). Elderly patients presented a higher incidence of ophthalmoplegia (p = 0.032) and a lower frequency of pituitary apoplexy before surgery (p < 0.05). Tumors with cavernous sinus invasion were treated surgically less frequently than in younger patients. Although patients with an American Society of Anesthesiologists score of 3 were more common in the elderly group (p < 0.05), no significant difference regarding surgical time, extent of resection, and hospitalization were observed. Elderly patients presented with more complications than patients < 60 years (32.7% vs 10%, p < 0.05). Complications observed in the elderly group included 5 CSF leaks (9%), 2 permanent diabetes insipidus cases (3.6%), 4 postoperative refractory hypertension cases (7.2%), 1 myocardial ischemia (1.8%), and 1 death (1.8%). Postoperative new anterior pituitary deficit was more common in the younger group (< 60 years old: 17.7%) than in the elderly (≥ 70 years old: 12.7%); however, there was no statistical difference. CONCLUSIONS Endoscopic transsphenoidal surgery for elderly patients with PAs may be associated with higher complication rates, especially secondary to early transitory complications, when compared with surgery performed in younger patients. Although the worst preoperative clinical status might be observed in this group, age alone is not associated with a worst final prognosis after endoscopic removal of nonfunctioning PAs.

RA05.09: THE INFLUENCE OF AGE ON OVERALL SURVIVAL AND COMPLICATIONS AFTER IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGEAL SURGERY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-29
Author(s):  
Nikolaj Baranov ◽  
Frans Van Workum ◽  
Jolijn Van Der Maas ◽  
Ewout Kouwenhoven ◽  
Marc Van Det ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Surgical Complications ◽  
Conflicts Of Interest ◽  
Postoperative Mortality ◽  
The Elderly ◽  
Elderly Group ◽  
Ivor Lewis ◽  
Significant Difference

Abstract Background Worldwide, the number of elderly patients suffering from esophageal cancer is increasing due to the increasing incidence of esophageal cancer and increasing life expectancy of the general population. The effect of age on morbidity, mortality and survival after Ivor Lewis totally minimally invasive esophagectomy (TMIE) with curative intention are not well known since elderly patients have been excluded in randomized trials. Methods A retrospective analysis of a prospectively documented database from December 2010 to June 2017 was performed, including all patients who underwent Ivor Lewis TMIE with curative intent for esophageal cancer in three Dutch hospitals. Patients younger than 75 years (younger group) were compared to patients aged 75 years or older (elderly group). Postoperative complications, in-hospital mortality, 30 and 90 days mortality, long-term complications and survival were compared between these two groups. Results Four hundred and forty-six patients were included, 89 patients in the elderly group and 357 patients in the younger group. In the elderly group, a significantly higher incidence of non-surgical complications (77.5% versus 66.7%; P = 0.048), cardiovascular complications (24.7% versus 14.0%; P = 0.014) and delirium (27.0% versus 11.8%; P = 0.000) was found. There was no significant difference in surgical complications, overall complications, 30-day mortality, 90-day mortality, 1-year survival and 2-year survival. Conclusion Although Ivor Lewis TMIE in elderly patients is associated with a higher rate of non-surgical complications, it can be safely performed without increasing postoperative mortality. Disclosure All authors have declared no conflicts of interest.

scholarly journals P1343DOES “FISTULA FIRST” FITS TO ELDERLY?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Valerio Patri­cia ◽  
Elsa Soares ◽  
Ana Farinha ◽  
Teresa Furtado ◽  
Catarina Abrantes ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Clinical Outcomes ◽  
Median Survival ◽  
The Elderly ◽  
Elderly Group ◽  
Disease Etiology ◽  
Younger Patients ◽  
Surgical Interventions ◽  
Comorbidity Burden ◽  
The Impact

Abstract Background and Aims The incident patients on hemodialysis (HD) are becoming older. However, the optimal type of initial permanent vascular access (VA) among the elderly is controversial. Patient comorbidities and life expectancy are important considerations in whether to place an arteriovenous fistula (AVF) or graft (AVG). We design an observational study to compare clinical outcomes of elderly (≥65 year old) versus younger patients, who underwent for first VA placement before initiation of renal replacement therapy, between January 2014 and December 2018. Method We evaluated successful use of VA, requirement of surgical interventions before successful use, VA in use after the first and third months on HD and clinical outcomes, until December 2019. The comorbidity burden was calculated through age-adjusted Charlson Comorbidity Index (aCCI). We also evaluated the impact of comorbidity burden on the VA type on HD start and mortality after HD initiation. Results We identified 252 predialysis patients who underwent for VA placement in our center. We created two groups based on age at the time of VA placement: there were 199 (79,0%) with age ≥ 65 years (the elderly group), and 53 (21,0%) younger patients. The elderly group presented a mean age of 76,3 ± 6,4 (maximum of 92) years on first VA placement; in the younger group, the mean age was 54,5 ± 9,1 (minimum of 26) years. The following analysis are presented for elderly versus younger group. On both groups there were a predominance of male gender (66,8%; 73,6%; p=0,498) and caucasian race (95,0%; 88,7%; p=0,193). At time of referral for AV placement, both groups presented similar mean estimated glomerular filtration rate by CKD-EPI equation (11,7 ± 3,2; 11,2 ± 3,2 mL/Kg/1,72m2; p=0,391). Elderly group presented a significant higher aCCI (7,3 ± 1,74; 9,0 ± 1,9; p&lt;0,001). The groups were also different in smoking status (6,0%; 30,8%; p&lt;0,001). There were no differences on kidney disease etiology between groups, with diabetes being the most prevalent (23,1%; 24,5%; p=0,856). For all patients, the first VA placed was AVF. Only two patient placed an AVG on second and third vascular accesses. The median number of VA placed were similar between the two groups [1,0 (1 to 4); 1,0 (1 to 2); p= 0,811], likewise the occurrence of early complications (9,5%; 5,7%; p=0,583) and the need for surgical interventions (46,7%; 47,2%; p=1,000). In both groups, the majority of patients started HD (80,4%; 90,6%; p=0,103), with similar successful use of the VA (68,1%; 75,0%; p=0,474). In multivariate logistic regression, proteinuria (measured at time of referral for AV placement) and heart failure (HF) were predictors to HD initiation through a central venous catheter (CVC). This model classified correctly 74,9% of cases, with an HF odds ratio (OR) of 4,149 [confident interval (CI) of 1,721 to 10,000] and a proteinuria OR of 1,148 (CI: 1,047 to 1,259). After the first month on HD, 34,8% of elderly patients needed a CVC, a number significantly different from the younger group (15,9%; p=0,023). The same result was observed after the third month (22,2%; 7,1%; p=0,028). During the time of follow-up, the mortality rate was higher in the elderly group who started HD (log Rank test = 0,004), with a median survival of 29,3 (0,1 to 89,8) months, when compared to the younger group [median survival of 38,3 (0,1 to 76,9) months]. Conclusion There were no difference in the kind of VA on HD start (definitive VA versus CVC) between the two groups. However, elderly patients presented more fistula failure in the first three months after HD initiation. The need of CVC due to nonfunctioning AVF on the first and three months after HD initiation was higher in the elderly. The analysis of the patients who started HD showed that the elderly group presented a significant reduced survival when compared to the youngest patients.

Acute kidney injury and major outcomes in cancer patients with no history of chronic kidney disease (CKD) with coronavirus 2019 (COVID-19) infection.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18816-e18816
Author(s):  
Cesar Simbaqueba ◽  
Omar Mamlouk ◽  
Kodwo Dickson ◽  
Josiah Halm ◽  
Sreedhar Mandayam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Kidney Injury ◽  
Hazard Model ◽  
Cancer Center ◽  
Icu Admission ◽  
Significant Difference ◽  
History Of

e18816 Background: Acute Kidney Injury (AKI) in patients with COVID-19 infection is associated with poor clinical outcomes. We examined outcomes (hemodialysis, mechanical ventilation, ICU admission and death) in cancer patients with normal estimated glomerular filtration rate (eGFR) treated in a tertiary referral center with COVID-19 infection, who developed AKI within 30 days of diagnosis. Methods: All patient data — demographics, labs, comorbidities and outcomes — were aggregated and analyzed in the Syntropy platform, Palantir Foundry (“Foundry”), as part of the Data-Driven Determinants of COVID-19 Oncology Discovery Effort (D3CODE) protocol at MD Anderson. The cohort was defined by the following: (1) positive COVID-19 test; (2) baseline eGFR >60 ml/min/1.73m2most temporally proximal lab results within 30 days prior to the patient’s infection. AKI was defined by an absolute change of creatinine ≥0.3 within 30 days after the positive COVID-19 test. Kaplan-Meier analysis was used for survival estimates at specific time periods and multivariate Cox Proportional cause-specific Hazard model regression to determine hazard ratios with 95% confidence intervals for major outcomes. Results: 635 patients with Covid-19 infection had a baseline eGFR >60 ml/min/1.73m2. Of these patients, 124 (19.5%) developed AKI. Patients with AKI were older, mean age of 61+/-13.2 vs 56.9+/- 14.3 years (p=0.002) and more Hypertensive (69.4% vs 56.4%, p=0.011). AKI patients were more likely to have pneumonia (63.7% vs 37%, p<0.001), cardiac arrhythmias (39.5% vs 20.7%, p<0.001) and myocardial infarction (15.3% vs 8.8%, p=0.046). These patients had more hematologic malignancies (35.1% vs 19%, p=0.005), with no difference between non metastatic vs metastatic disease (p=0.284). There was no significant difference in other comorbidities including smoking, diabetes, hypothyroidism and liver disease. AKI patients were more likely to require dialysis (2.4% vs 0.2%, p=0.025), mechanical ventilation (16.1% vs 1.8%, p<0.001), ICU admission (43.5% vs 11.5%, p<0.001) within 30 days, and had a higher mortality at 90 days of admission (20.2% vs 3.7%, p<0.001). Multivariate Cox Proportional cause-specific Hazard model regression analysis identified history of Diabetes Mellitus (HR 10.8, CI 2.42 - 48.4, p=0.001) as an independent risk factor associated with worse outcomes. Mortality was higher in patients with COVID-19 infection that developed AKI compared with those who did not developed AKI (survival estimate 150 days vs 240 days, p=0.0076). Conclusions: In cancer patients treated at a tertiary cancer center with COVID-19 infection and no history of CKD, the presence of AKI is associated with worse outcomes including higher 90 day mortality, ICU stay and mechanical ventilation. Older age and hypertension are major risk factors, where being diabetic was associated with worse clinical outcomes.

Typical Trigeminal Neuralgia: Comparison of Results between Patients Older and Younger than 65 Years Operated on with Microvascular Decompression by Retrosigmoid Approach

2019 ◽  
Vol 81 (01) ◽  
pp. 028-032 ◽  
Author(s):  
Luciano Mastronardi ◽  
Franco Caputi ◽  
Alessandro Rinaldi ◽  
Guglielmo Cacciotti ◽  
Raffaelino Roperto ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Elderly Patients ◽  
Microvascular Decompression ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Retrosigmoid Approach ◽  
Younger Patients ◽  
Significant Difference ◽  
Elderly Cohort

Abstract Objective The incidence of typical trigeminal neuralgia (TN) increases with age, and neurologists and neurosurgeons frequently observe patients with this disorder at age 65 years or older. Microvascular decompression (MVD) of the trigeminal root entry zone in the posterior cranial fossa represents the etiological treatment of typical TN with the highest efficacy and durability of all treatments. This procedure is associated with possible risks (cerebellar hematoma, cranial nerve injury, stroke, and death) not seen with the alternative ablative procedures. Thus the safety of MVD in the elderly remains a topic of discussion. This study was conducted to determine whether MVD is a safe and effective treatment in older patients with TN compared with younger patients. Methods In this retrospective study, 28 patients older than 65 years (elderly cohort: mean age 70.9 ± 3.6 years) and 38 patients < 65 years (younger cohort: mean age 51.7 ± 6.3 years) underwent MVD via the keyhole retrosigmoid approach for type 1 TN (typical) or type 2a TN (typically chronic) from November 2011 to November 2017. A 75-year-old patient and three nonelderly patients with type 2b TN (atypical) were excluded. Elderly and younger cohorts were compared for outcome and complications. Results At a mean follow-up 26.0 ± 5.5 months, 25 patients of the elderly cohort (89.3%) reported a good outcome without the need for any medication for pain versus 34 (89.5%) of the younger cohort. Twenty-three elderly patients with type 1 TN were compared with 30 younger patients with type 1 TN, and no significant difference in outcomes was found (p > 0.05). Five elderly patients with type 2a TN were compared with eight younger patients with type 2a TN, and no significant difference in outcomes was noted (p > 0.05). There was one case of cerebrospinal fluid leak and one of a cerebellar hematoma, both in the younger cohort. Mortality was zero in both cohorts. Conclusions On the basis of our experience and the international literature, age itself does not seem to represent a major contraindication of MVD for TN.

Does endoscopy accurately predict response to chemoradiation in patients undergoing esophagectomy?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4024-4024 ◽  
Author(s):  
I. S. Sarkaria ◽  
N. Rizk ◽  
M. Bains ◽  
R. Flores ◽  
B. Park ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Squamous Cell ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Endoscopic Biopsy ◽  
Response To Treatment ◽  
Cancer Center ◽  
Local Disease ◽  
Mean Time

4024 Background: Endoscopic biopsy after chemoradiation therapy (CRT) for esophageal cancer has been used to determine response to treatment. To test the validity of this methodology, we conducted a study to determine if endoscopic biopsy can accurately establish evidence of local pathologic complete response (pCR), defined as no residual local disease in the esophagus, in patients undergoing esophagectomy after CRT. Methods: We retrospectively queried a prospectively maintained database for patients seen at Memorial Sloan-Kettering Cancer Center from 1996 to the present who underwent, 1) CRT for esophageal cancer with the intent to proceed to esophagectomy post-treatment, and 2) post-CRT endoscopic biopsy. Data points included the pathology of the post-CRT endoscopy and resected surgical specimens, tumor histology, mean time from end of CRT to endoscopic biopsy, and mean time from endoscopic biopsy to surgery. Correlations were analyzed by the chi-square test and one way analysis of variance. Results: One-hundred thirty seven patients meeting our search criteria were identified. Ninety-percent of patients received cisplatin based chemotherapy and 5040 cGy of radiation. One-hundred four patients had a negative pathology on endoscopic biopsy. A negative pathology at endoscopic biopsy was a poor predictor of pCR (Positive Predictive Value = 37.5%), with 65% of these patients having residual local disease at esophagectomy. This result was not influenced by mean time from completion of CRT to endoscopy (p=0.5), or by mean time from endoscopy to surgery (p=0.47). A positive pathology at endoscopic biopsy was highly predictive of residual disease (p<0.001). When analyzed by histology, a negative endoscopic biopsy better predicted response for squamous cell carcinomas versus adenocarcinomas (p<0.001). Conclusions: Although improved for squamous cell cancers versus adenocarcinomas, a disease free endoscopic biopsy does not appear to be a useful predictor of a complete pathologic response after CRT. Neither the time to endoscopy after CRT, nor the time to surgery after endoscopy, influence this finding. No significant financial relationships to disclose.

Can a conventional schedule of radiation therapy be administered to elderly patients with glioblastoma multiforme?

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 12516-12516
Author(s):  
S. Manfrida ◽  
G. R. D’Agostino ◽  
C. Anile ◽  
G. Mantini ◽  
G. Colicchio ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Elderly Patients ◽  
Conformal Radiotherapy ◽  
Residual Tumor ◽  
The Elderly ◽  
Elderly Group ◽  
Female Ratio ◽  
Younger Patients ◽  
Tumor Bed ◽  
Grade 3

12516 Background: We retrospectively evaluate the tolerance and the efficacy of a conventional schedule of radiotherapy in elderly patients with glioblastoma multiforme (GBM). Methods: Eighty-three consecutive patients affected by glioblastomas were treated between 2001 and 2006. We divided our series in two groups: patients under 65 years (n=52) and patients ≥ 65 years old (n=31). In the elderly group, median age was 68 years (range, 65–80). 17 patients (54,8%) were female, 14 male (45,2%); 20 patients (64,5%) <70 years, 11 patients (35,5%) ≥70 years. Among the younger patients, median age was 51 years (range 25–64), male/female ratio 32/20 (61.5%/38.5%).Twenty-seven out of 31 elderly patients (87,1%) were treated with conformal radiotherapy (CRT, 5940 cGy, 180 cGy/day; CTV2: tumor bed + residual tumor if present + oedema, 3960 cGy; CTV1: tumor bed + residual tumor if present + margins, 1980 cGy). Four out of 31 patients received an intensification dose of xxxx cGy by stereotactic conformal radiotherapy (SRT, 12,9%); among the younger patients, 25/52 were treated with CRT (48,1%) and 27/52 with SRT (51,9%). Concomitant and adjuvant chemotherapy was administered by temozolomide (TMZ).Toxicity was evaluated according to RTOG score. Survival analysis were performed using Kaplan-Meier method and log-rank testing was used for comparison of groups. Results: In the elderly group, neurological acute toxicity was observed in 6/31 patients (19,4%), with grade 3 in two patients. In the under 65 group, 5/52 patients (9,6%) had neurotoxicity (Grade 3 in two patients).This difference was not statistically different.At a median follow-up period of 28 months (range, 3–61), median progression-free survival (PFS) was 11 months in the ≥65 group and 10 months in the under 65 group; median overall survival (OS) was respectively 17 months and 22 months. 1- year survival was respectively 77.6% and 74.5%. Conclusions: In our analysis age did not seem to be a limiting factor in the choice of the therapeutic strategy for patients with glioblastoma multiforme. No significant financial relationships to disclose.

Functional morbidities in patients ≥ 65 years compared with younger patients undergoing organ preservation therapy (OPT) for squamous cell carcinoma (SCC) of larynx (L) or propharynx (OP)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16533-16533
Author(s):  
J. Ramanarayanan ◽  
M. Burstein ◽  
F. A. Brodzik ◽  
A. I. Jackson ◽  
S. Mehdi
Keyword(s):  
Weight Loss ◽  
Functional Outcome ◽  
Voice Quality ◽  
Late Toxicity ◽  
The Elderly ◽  
Elderly Group ◽  
Similar Treatment ◽  
Younger Patients ◽  
Mean Values ◽  
Altered Fractionation

16533 Background: Advanced age is shown to be associated with increased late toxicity and minimal clinical benefit in head and neck cancer patients receiving aggressive or combined modality therapies. Elderly may also have delayed functional recovery after OPT. We conducted a retrospective study in patients = 65 years with L or O SCC undergoing OPT to compare functional outcome/ recovery with younger patients undergoing similar treatment. Methods: Patients with L or O SCC from January 1996-January 2006 who underwent OPT were retrospectively studied and stratified into 2 groups: = 65 or < 65 years based on age at diagnosis. Dysphagia, gastrostomy (g) tube dependence, speech quality and weight loss at diagnosis, 3 and 9 months post therapy were compared. Swallowing and speech were evaluated by 2 specially trained therapists based on the Swallowing Performance Scale and GBRAS Scale (perceptual impression of voice quality) respectively. Student z-test and t-test were used in statistical analysis for comparison between patient proportion and mean values. Results: One hundred and twenty patients (L 74 and OP 46) received OPT, of which 43 were excluded (recurrence/inadequate records). Of the 77 (L 54 and O 23) patients analyzed (KPS 80–100), 44 (57%) were = 65 and 33 (43%) <65; more patients aged <65 had advanced stage; 14 patients (31%) = 65 and 16 (48%) <65 received CRT or altered fractionation RT, rest of the patients received standard RT. Elderly group had greater proportion of patients with continued weight loss and higher incidence of dysphonia (70% vs 43% z-score 2.97, p=0.003) at 3 and 9 months than younger patients. Of 19 patients in the elderly group with g-tube, 13 were g-tube dependant at 3 months (68%) vs 12/23 (52%) in the younger population. Conclusions: Elderly may have persistent functional morbidity compared to younger patients receiving similar OPT. As the goal of OPT is to improve functional outcome, careful assessment of risk benefit ratio in the elderly is warranted before administering aggressive therapies. No significant financial relationships to disclose.

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