Management of Bone Metastatic Disease in Geriatric/ Elderly Patients

e21521 Background: Adjuvant radiation therapy is an essential part of combined limb sparing treatment of STS. The recommended dose of radiation lies in the range of 60 Gy in standard fractionation of 1.8-2 Gy. Elderly or medically unfit patients often have difficulty in completing 6-7w of daily treatment. A prolonged course of radiation may be interrupted by acute side effects, which sometimes demands further extension of the overall course or even discontinuation of treatment. We intended to evaluate the efficacy of a hypofractionated adjuvant approach with radiation therapy for STS in the elderly and debilitated patients. Methods: 21 elderly patients were treated with a short course of adjuvant RT (39 to 48 Gy, 3 Gy per fraction) for STS. The medical records of the patients were retrospectively reviewed for the local or distant recurrence and side effects of RT. Results: Overall, the hypofractionated irradiation regimen of 39-48 Gy in 13-16 fractions was well tolerated with only 3 patients developing Grade 2-3 acute toxicity (mainly dermatitis). Three patients suffered from delayed Grade 2-3 toxicity (chronic pain, skin atrophy, teleangiectasiae) scaled according to CTSC. The mean time from the surgery until the initiation of RT was 65 days (SD 21.6). Mean RT time was 18.4 (SD 3) days. No delay of treatment due to acute toxicity was registered. All patients except for one were able to receive RT in the ambulatory setting. With a mean follow-up of 532 days (SD: 325), three local recurrences (14%) were detected. Three of eight patients with distant metastases died of sarcoma (graph 1). One patient with metastatic disease in the lung received salvage stereo tactic radiation therapy and was still alive 6 month after completion of SBRT with no evidence of disease. At a mean 532 days of follow up three local recurrences (14%) were detected .Eight patients (38%) had lung metastases during the observed period. Three of them died from metastatic disease. The hypofractionated radiation was well tolerated with minimum long term side effects. Conclusions: Hypofractionated adjuvant radiation appears to be an effective treatment in terms of local control in elderly and debilitated patients.

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Outcomes of severe sepsis in very elderly (age >80 years) patients with metastatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9558 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9558-9558

Author(s):

Zahra Touqir ◽

Shagufta Shaheen ◽

Shivanck Upadhyay ◽

Creticus Petrov Marak ◽

Gagan Kumar ◽

...

Keyword(s):

Mechanical Ventilation ◽

Severe Sepsis ◽

Elderly Patients ◽

Metastatic Disease ◽

Metastatic Cancer ◽

Invasive Mechanical Ventilation ◽

Care Providers ◽

Very Elderly ◽

Central Venous ◽

Discharge Disposition

9558 Background: With better treatment and prolonged life expectancy of cancer patients, more elderly patients with metastatic cancer are being treated aggressively for sepsis. There has been philosophical debate about how aggressive the treatment should be for very elderly patients with metastatic disease admitted to intensive care unit with severe sepsis. The data with regards to the outcome of severe sepsis in those above 80 years with metastatic disease is very limited. Methods: Using the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample 2007-2008, patients older than 80 years, discharged with severe sepsis were identified using ICD-9-CM codes. Those with metastatic disease were identified using ICD-9-CM codes 196-199. The outcomes studied were mortality and discharge disposition. We also examined the rates of invasive mechanical ventilation, blood transfusion, use of central venous catheter, tracheostomy and dialysis. The outcomes were compared to those who did not have cancer. Chi square test was used to compare the variables. Significance was defined as p value <0.05. Results: There were 458,443 discharges with severe sepsis in patients aged ≥80 years. Of these 3.3% had metastatic disease. The in-hospital mortality was significantly higher in those with metastatic disease (43.7% vs. 33.3%, p<0.001). The discharge disposition of the very elderly is shown in the Table. The rates of invasive mechanical ventilation, tracheostomy, use of central venous lines and dialysis were similar in both the groups. Blood transfusions were observed to be higher in metastatic group. Conclusions: Resource utilization in elderly with severe sepsis is similar regardless of the presence of metastatic disease. However, the mortality is significantly higher in those with metastatic disease. Of the survivors, only a fraction reaches home with independent functioning. Involvement of palliative care services at an early stage and addressing code status promptly during the beginning of each hospitalization may help relieve resource and financial burden to health care providers. [Table: see text]

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Postoperative mortality and need for transitional care following liver resection for metastatic disease in elderly patients: a population‐level analysis of 4026 patients

HPB ◽

10.1111/j.1477-2574.2012.00577.x ◽

2012 ◽

Vol 14 (12) ◽

pp. 863-870 ◽

Cited By ~ 14

Author(s):

Sonia T. Orcutt ◽

Avo Artinyan ◽

Linda T. Li ◽

Eric J. Silberfein ◽

David H. Berger ◽

...

Keyword(s):

Liver Resection ◽

Elderly Patients ◽

Metastatic Disease ◽

Transitional Care ◽

Postoperative Mortality ◽

Population Level ◽

Level Analysis

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Determinants of early distant metastatic disease in elderly patients with breast cancer

The American Journal of Surgery ◽

10.1016/j.amjsurg.2006.04.012 ◽

2006 ◽

Vol 192 (3) ◽

pp. 317-321 ◽

Cited By ~ 7

Author(s):

Anees B. Chagpar ◽

Kelly M. McMasters ◽

Robert C. Martin ◽

Cynthia Thoene ◽

Jacob Y. Nurko ◽

...

Keyword(s):

Breast Cancer ◽

Elderly Patients ◽

Metastatic Disease ◽

Distant Metastatic Disease

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Hepatic abscesses in elderly patients mimicking metastatic disease

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf03167790 ◽

2001 ◽

Vol 170 (4) ◽

pp. 251-253 ◽

Cited By ~ 13

Author(s):

R. S. Ryan ◽

H. Al-Hashimi ◽

M. J. Lee

Keyword(s):

Elderly Patients ◽

Metastatic Disease

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Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.552 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 552-552

Author(s):

Hadar Goldvaser ◽

Noa Katz Shroitman ◽

Irit Ben-Aharon ◽

Ofer Purim ◽

Yulia Kundel ◽

...

Keyword(s):

Colorectal Cancer ◽

Family History ◽

Elderly Patients ◽

Metastatic Disease ◽

Performance Status ◽

Clinicopathological Characteristics ◽

Clinical Entity ◽

Control Group ◽

Cancer Specific Survival ◽

History Of

552 Background: Colorectal cancer (CRC) in Octogenarians is an emerging clinical entity. It is currently unclear whether these patients have unique features and whether their treatment should differ from younger patients with CRC. The aim of this study was to better characterize this patients population. Methods: A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of ≥ 80 years between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Results: The study included 350 patients, followed for a median of 40.2 months (range 1.8-97.5). Several significant differences were noted. Elderly patients had a higher proportion of Ashkenazi ethnicity (p < 0.001), lower rates of family history of any cancer (p < 0.001) and family history of CRC (p = 0.006), and a higher rate of personal history of other malignancies (p = 0.035). CRC diagnosis by screening was less frequent in octogenarians (p < 0.001) and their performance status at presentation was worse. Octogenarians were more likely to have tumors located in the right colon (p = 0.029) and had a lower prevalence of well differentiated histology (p = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of performance status. Their 5-year cancer specific survival was worse (63.4% vs.77.6%, p = 0.009), both for metastatic (p = 0.03) and for non-metastatic disease (p = 0.028). Conclusions: Elderly patients with CRC presented several differences in clinical and tumor characteristics compared to their younger counterparts. They were less likely to receive treatment and they had worse outcome. Further research is needed to better define this growing patient population and to establish their optimal treatment.

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