Strahlentherapie und Onkologie

, Volume 195, Issue 1, pp 62–68 | Cite as

Feasibility of radiotherapy in nonagenarian patients: a retrospective study

  • L. KocikEmail author
  • H. Geinitz
  • C. Track
  • M. Geier
  • C. Nieder
Original Article



Specific information about radiation therapy in nonagenarians is limited. In order to shed more light on the feasibility of radiotherapy in this challenging subgroup, a retrospective study was performed.


The data of 93 consecutive patients receiving irradiation treatment at the Department of Radiation Oncology, Ordensklinikum Linz Barmherzige Schwestern between June 2005 and December 2016 were analyzed. Patient- and treatment-related factors were extracted from the patient records. Overall survival (OS) was defined as time from irradiation to death or last follow-up. The survival rates were analyzed using the Kaplan-Meier method and log-rank test.


The study population of 93 patients was between 90 and 99 years old (median 91 years). It included 59 women (63%) and 34 men (37%). Of these, 38 (41%) received definitive radiotherapy, 14 (15%) received neoadjuvant or adjuvant radiotherapy, whereas a palliative regimen was prescribed in 44% of the cases (n = 41). In all, 79 patients (85%) were able to complete their prescribed course of radiotherapy. While 16 (17%) patients reported grade 2 toxicities or higher, 4 had ≥grade 3 side effects (4%). The median survival was significantly higher in patients treated with adjuvant, neoadjuvant or definitive radiotherapy (13.8 months) compared to patients treated with palliative radiotherapy (3.6 months; p < 0.001).


Even in patients managed without preradiotherapy comprehensive geriatric assessment, carefully planned fractionated radiotherapy was feasible and resulted in acceptable rates of acute toxicities.


Aged, 80 and over Radiation Oncology Geriatric assessment Dose Fractionation Survival Rate 

Strahlentherapie bei „Nonagenerians“: eine retrospektive Machbarkeitsstudie



In der Literatur sind nur eingeschränkt Daten zu Strahlentherapie für „Nonagenerians“ verfügbar. Um die Durchführbarkeit einer Strahlentherapie in dieser Population beurteilen zu können, wurde diese retrospektive Analyse durchgeführt.


Die Daten von 93 Patienten, die im Zeitraum von Juni 2005 bis Dezember 2016 an der Abteilung für Radioonkologie im Ordensklinikum Linz Barmherzige Schwestern eine Strahlentherapie erhielten, wurden retrospektiv ausgewertet. Behandlungs- und Patientendaten wurden den Krankenakten entnommen. Das Gesamtüberleben („overall survival“, OS) wurde definiert als die Zeit von der Behandlung bis zum Zeitpunkt entweder des Versterbens oder des letzten Follow-up. Die Analyse der Überlebensdaten erfolgte nach Kaplan-Meier und unter Verwendung des Log-rank-Testverfahrens.


Die Studienpopulation war zwischen 90 und 99 Jahre alt (Median 91), eingeschlossen wurden 59 weibliche (63 %) und 34 männliche (37 %) Patienten. Von diesen wurden 38 (41 %) definitiv behandelt, 14 (15 %) adjuvant oder neoadjuvant, eine palliative Behandlung erhielten 41 Patienten (44 %). Insgesamt konnten 79 Patienten (85 %) die verordnete Radiotherapie abschließen. Grad-2-Nebenwirkungen oder stärkere beschrieben 16 (17 %) Patienten, 4 (4 %) hatten ≥Grad-3-Toxizitäten. Das mediane Überleben der Patienten, die eine definitive, neoadjuvante oder adjuvante Radiotherapie erhalten hatten, war mit 13,8 Monaten im Vergleich zu dem der palliativ therapierten Patienten (3,8 Monate) signifikant höher (p < 0,001).


Auch bei Patienten, die zuvor keinem ausführlichen geriatrischen Assessment unterzogen wurden, war eine sorgsam geplante fraktionierte Strahlentherapie – mit einer akzeptablen Rate an akuten therapieassoziierten Nebenwirkungen – gut durchführbar.


Alter, 80 und höher Radioonkologie Geriatrisches Assessment Dosisfraktionierung Überlebensraten 


Compliance with ethical guidelines

Conflict of interest

L. Kocik, H. Geinitz, C. Track, M. Geier and C. Nieder declare that they have no competing interests.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Vineis P, Wild CP (2014) Global cancer patterns: causes and prevention. Lancet 383:549–557CrossRefGoogle Scholar
  2. 2.
    Rodrigues G, Sanatani M (2012) Age and comorbidity considerations related to radiotherapy and chemotherapy administration. Semin Radiat Oncol 22:277–283CrossRefGoogle Scholar
  3. 3.
    Bouzereau V, Le Caer F, Guardiola E, Scavennec C, Barriere JR, Chaix L, Le Caer H (2013) Experience of multidisciplinary assessment of elderly patients with cancer in a French general hospital during 1year: a new model care study. J Geriatr Oncol 4:394–401CrossRefGoogle Scholar
  4. 4.
    Nieder C, Angelo K, Haukland E, Pawinski A (2014) Survival after palliative radiotherapy in geriatric cancer patients. Anticancer Res 34:6641–6645Google Scholar
  5. 5.
    Chen L, Shen C, Redmond KJ, Page BR, Kummerlowe M, Mcnutt T, Bettegowda C, Rigamonti D, Lim M, Kleinberg L (2017) Use of stereotactic radiosurgery in elderly and very elderly patients with brain metastases to limit toxicity associated with whole brain radiation therapy. Int J Radiat Oncol Biol Phys 98:939–947CrossRefGoogle Scholar
  6. 6.
    Cassidy RJ, Patel PR, Zhang X, Press RH, Switchenko JM, Pillai RN, Owonikoko TK, Ramalingam SS, Fernandez FG, Force SD, Curran WJ, Higgins KA (2017) Stereotactic body radiotherapy for early-stage non-small-cell lung cancer in patients 80 years and older: a multi-center analysis. Clin Lung Cancer 18:551–558.e6CrossRefGoogle Scholar
  7. 7.
    Arnold BN, Thomas DC, Rosen JE, Salazar MC, Detterbeck FC, Blasberg JD, Boffa DJ, Kim AW (2017) Effectiveness of local therapy for stage I non-small-cell lung cancer in nonagenarians. Surgery 162:640–651CrossRefGoogle Scholar
  8. 8.
    Franceschini D, De Rose F, Cozzi L et al (2017) Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer. Strahlenther Onkol 193:385CrossRefGoogle Scholar
  9. 9.
    Andrä C, Klein A, Dürr HR et al (2017) External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities. Strahlenther Onkol 193:604CrossRefGoogle Scholar
  10. 10.
    Thompson A, Cone R, Gao H, Hammond E, Fraser D, Back MF (2012) Is advanced age a barrier to effective cancer treatment? The experience of nonagenarians receiving radiation therapy. Asia Pac J Clin Oncol 8:255–259CrossRefGoogle Scholar
  11. 11.
    Chargari C, Moriceau G, Auberdiac P, Guy JB, Assouline A, Tinquaut F, Falk AT, Eddekkaoui H, Bourmaud A, Coscas Y, Annede P, Rivoirard R, Mery B, Trone JC, Otmezguine Y, Pacaut C, Bauduceau O, Vedrine L, Merrouche Y, Magne N (2014) Feasibility of radiation therapy in patients 90 years of age and older: a French multicentre analysis. Eur J Cancer 50:1490–1497CrossRefGoogle Scholar
  12. 12.
    Rivoirard R, Moncharmont C, Assouline A, Auberdiac P, Mery B, Falk AT, Annède P, Trone JC, Guy JB, Vial N, Fournel P, Merrouche Y, Chargari C, Magné N (2015) Radiotherapy for head and neck cancer in nonagenarian patients: a possible cornerstone? Eur Arch Otorhinolaryngol 272:719–725CrossRefGoogle Scholar
  13. 13.
    Méry B, Ndong SM, Guy JB, Assouline A, Falk AT, Valeille A, Trone JC, Rivoirard R, Auberdiac P, Vallard A, Espenel S, Moriceau G, Collard O, Bosacki C, Jacquin JP, de Laroche G, Fournel P, Chargari C, Magné N (2016) Radiotherapy for gynecologic cancer in nonagenarian patients: a framework for new paradigms. Chin J Cancer 35:43CrossRefGoogle Scholar
  14. 14.
    Méry B, Falk AT, Assouline A, Trone JC, Guy JB, Rivoirard R, Auberdiac P, Escure JL, Moncharmont C, Moriceau G, Almokhles H, de Laroche G, Pacaut C, Guillot A, Chargari C, Magné N (2015) Hypofractionated radiation therapy for treatment of bladder carcinoma in patients aged 90 years and more: a new paradigm to be explored? Int Urol Nephrol 47:1129–1134CrossRefGoogle Scholar
  15. 15.
    Vallard A, Rancoule C, Guy JB, Assouline A, Falk AT, Auberdiac P, Langrand-Escure J, Chargari C, Magné N (2017) Radiotherapy among nonagenarians with anal or rectal carcinoma: should we avoid or adapt treatment? Chin J Cancer 36:56CrossRefGoogle Scholar
  16. 16.
    Oguchi M, Ikeda H, Watanabe T, Shikama N, Ohata T, Okazaki Y, Kiyono K, Sone S (1998) Experiences of 23 patients ≥ 90 years of age treated with radiation therapy. Int J Radiat Oncol Biol Phys 41:407–413CrossRefGoogle Scholar
  17. 17.
    Videtic GMM, Woody NM, Reddy CA, Stephans KL (2017) Never too old: a single-institution experience of stereotactic body radiation therapy for patients 90 years and older with early stage lung cancer. Pract Radiat Oncol. Google Scholar
  18. 18.
    Spyropoulou D, Pallis AG, Leotsinidis M, Kardamakis D (2014) Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer. J Geriatr Oncol 5:20–25CrossRefGoogle Scholar
  19. 19.
    Shahrokni A, Kim SJ, Bosl GJ, Korc-Grodzicki B (2017) How we care for an older patient with cancer. J Oncol Pract 13:95–102CrossRefGoogle Scholar
  20. 20.
    Somasundar P, Mourey L, Lozza L, Maggi S, Stepney R (2017) Advances in geriatric oncology: a multidisciplinary perspective. Tumori. Google Scholar
  21. 21.
    Li D, Soto-Perez-de-Celis E, Hurria A (2017) Geriatric assessment and tools for predicting treatment toxicity in older adults with cancer. Cancer J 23:206–210CrossRefGoogle Scholar
  22. 22.
    Ethun CG, Bilen MA, Jani AB, Maithel SK, Ogan K, Master VA (2017) Frailty and cancer: implications for oncology surgery, medical oncology, and radiation oncology. Ca Cancer J Clin 67:362–377CrossRefGoogle Scholar
  23. 23.
    Kirkhus L, Šaltytė Benth J, Rostoft S, Grønberg BH, Hjermstad MJ, Selbæk G, Wyller TB, Harneshaug M, Jordhøy MS (2017) Geriatric assessment is superior to oncologists’ clinical judgement in identifying frailty. Br J Cancer 117:470–477CrossRefGoogle Scholar
  24. 24.
    Takahashi M, Takahashi M, Komine K, Yamada H, Kasahara Y, Chikamatsu S, Okita A, Ito S, Ouchi K, Okada Y, Imai H, Saijo K, Shirota H, Takahashi S, Mori T, Shimodaira H, Ishioka C (2017) The G8 screening tool enhances prognostic value to ECOG performance status in elderly cancer patients: a retrospective, single institutional study. PLoS ONE 12:e179694CrossRefGoogle Scholar
  25. 25.
    Osborne GEC, Appleyard SA, Gilbert DC, Jones CI, Lorimer C, Villanueva M, Peasgood E, Robinson A, Nikapota A, Ring A (2017) Comprehensive geriatric assessment in men aged 70 years or older with localised prostate cancer undergoing radical radiotherapy. Clin Oncol (R Coll Radiol) 29:609–616CrossRefGoogle Scholar
  26. 26.
    Ommundsen N, Wyller TB, Nesbakken A et al (2014) Frailty is an independent predictor of survival in older patients with colorectal cancer. Oncologist 19(12):1268–1275. CrossRefGoogle Scholar
  27. 27.
    Ghebre RG, Posthuma R, Vogel RI, Geller MA, Carson LF (2011) Effect of age and comorbidity on the treatment and survival of older patients with vulvar cancer. Gynecol Oncol 121(3):595–599. CrossRefGoogle Scholar
  28. 28.
    Jatoi A, Muss H, Allred JB et al (2016) Social support and its implications in older, early-stage breast cancer patients in CALGB 49907 (alliance A171301). Psychooncology 25(4):441–446. CrossRefGoogle Scholar
  29. 29.
    Aizer AA, Chen M‑H, McCarthy EP et al (2013) Marital status and survival in patients with cancer. J Clin Oncol 31(31):3869–3876. CrossRefGoogle Scholar
  30. 30.
    Apariio T, Jouve JL, Teillet L et al (2013) Geriatric factors predict chemotherapy feasibility: ancillary results of FFCD 2001-02 phase III study in first-line chemotherapy for metastatic colorectal cancer in elderly patients. J Clin Oncol 31(11):1464–1470. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiation OncologyOrdensklinikum Linz Barmherzige SchwesternLinzAustria
  2. 2.Department of Oncology and Palliative MedicineNordland Hospital TrustBodøNorway
  3. 3.Department of Clinical Medicine, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway

Personalised recommendations