Advertisement

Are endometrial cancer radiotherapy results age related?

  • Á. Rovirosa
  • K. S. Cortés
  • C. Ascaso
  • A. Glickman
  • S. Valdés
  • A. Herreros
  • C. Camacho
  • J. Sánchez
  • Y. Zhang
  • Y. Li
  • S. Sabater
  • M. Arenas
  • A. Torne
Research Article

Abstract

Objective

To analyze the impact of age on radiotherapy results based on cancer-specific survival (CSS), vaginal-cuff relapses (VCR) and complications analysis in 438 patients with endometrial carcinoma (EC) receiving postoperative radiotherapy (PRT) divided into three age groups for analysis.

Materials and methods

From 2003 to 2015, 438 patients with EC were treated with PRT and divided into three age groups: Group-1: 202 patients < 65 years; Group-2: 210 patients ≥ 65 and < 80 years; Group-3: 26 patients ≥ 80 years. Vaginal toxicity was assessed using the objective LENT-SOMA criteria and RTOG scores were recorded for the rectum, bladder, and small bowel. Statistics: Chi square and Student’s t tests, Kaplan–Meier survival study for analysis of CSS.

Results

The mean follow-up was 5.6 years in Group-1, 5.6 years in Group-2 and 6.3 years in Group-3 (p = 0.38). No differences were found among the groups in distribution of stage, grade, myometrial invasion, Type 1 vs. 2 EC and VLSI (p = 0.97, p = 0.52, p = 0.35, p = 0.48, p = 0.76, respectively). There were no differences in rectal, bladder and vagina late toxicity (p = 0.46, p = 0.17, p = 0.75, respectively). A better CSS at 5 years was found in Group-1 (p = 0.006), and significant differences were found in late severe small bowel toxicity in Group-3 (p = 0.005). VCR was increased in Group-3 (p = 0.017).

Conclusions

Patients ≥ 65 years had a worse outcome in comparison to younger patients. Late vaginal, rectal and bladder toxicities were similar in the three groups, although an increase of severe late small bowel toxicity led to IMRT in patients ≥ 80 years. Further larger studies are needed including quality of life analysis in patients ≥ 80 years.

Keywords

Radiotherapy results Toxicity Age Endometrial carcinoma 

Notes

Acknowledgements

This study was supported by a grant from the Spanish Association Against Cancer (AECC) Foundation (PS14152506ROVI).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study has been approved by the appropriate ethics committee and it has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Mohile SG, Xian Y, Dale W, Fisher SG, Rodin M, Morrow GR, et al. Association of a cancer diagnosis with vulnerability and frailty in older medicare beneficiaries. J Natl Cancer Inst. 2009;101:1206–15.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gómez Portilla A, Martínez de Lecea C, Cendoya I, Olabarría I, Martín E, Magrach L, et al. Prevalence and treatment of oncologic disease in elderly-an impending challenge. Rev Esp Enfer Dig (Madrid). 2008;100(11):706–15.Google Scholar
  3. 3.
    Hennnequin C, Gullem S, Quero L. Radiotherapy in elderly patients, recommendations for the main localizations: breast, prostate and gynaecological cancers. Cancer/Radiothérapie. 2015;19:397–403.CrossRefGoogle Scholar
  4. 4.
    Rauh-Hain JA, Pepin KJ, Meyer LA, Clemmer JT, Lu KH, Rice LW, et al. Management for elderly women with advanced-stage, high-grade endometrial cancer. Obstet Gynecol. 2015;126(6):1198–206.CrossRefPubMedGoogle Scholar
  5. 5.
    Yoshida H, Imai Y, Fujiwara K. Combination chemotherapy with docetaxel and carboplatin for elderly patients with endometrial cancer. Mol Clin Oncol. 2016;4(5):783–8.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dandapani SV, Zhang Y, Jennelle R, Lin YG. Radiation-associated toxicities in obese women with endometrial cancer: more than just BMI? Sci World J. 2015;483208:1–6.CrossRefGoogle Scholar
  7. 7.
    Uccella S, Bonzini M, Palomba S, Fanfani F, Malzoni M, Ceccaroni M, et al. Laparoscopic vs. open treatment of endometrial carcinoma in elderly and very elderly: ana ge-stratified multicentre study of 1606 women. Gynecol Oncol. 2016;141(2):2011–7.CrossRefGoogle Scholar
  8. 8.
    Bourgin C, Lambaudie E, Houvenaeghel G, Foucher F, Levêque J, Lavoué V. Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management. Eur J Surg Oncol. 2016.  https://doi.org/10.1016/j.ejso.2016.10.022.Google Scholar
  9. 9.
    Backes FJ, El Naggar AC, Farrell MR, Brudie LA, Ahmad S, Salani R, et al. Perioperative outcomes for laparotomy compared to robotic surgical staging of endometrial cancer in the elderly: a retrospective cohort. Int J Gynecol Cancer. 2016;26(9):1717–21.CrossRefPubMedGoogle Scholar
  10. 10.
    Dumas L, Ring A, Butler J, Kalsi T, Harari D, Banerjee S. Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev. 2016;50:99–108.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Karabuga H, Gultekin M, Tulunay G, Yuce K, Ayhan A, Yuce D, et al. Assessing the quality of life in patients with endometrial cancer treated with adjuvant therapy. Int J Gynecol Cancer. 2015;25(8):1526–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Rovirosa A, Ascaso C, Sánchez-Reyes A, Herreros A, Abellana R, Pahisa J, et al. Three or four fractions of 4–5 Gy per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2011;81:412–23.CrossRefGoogle Scholar
  13. 13.
    Rovirosa A, Ascaso C, Arenas M, Sabater S, Herreros A, Camarasa A, et al. Can we shorten the overall treatment time in postoperative brachytherapy of endometrial carcinoma? Comparison of two brachytherapy schedules. Radiother Oncol. 2015;116:143–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Rovirosa Á, Ascaso C, Herreros A, Sánchez J, Holub K, Camarasa A, et al. A new short daily brachytherapy schedule in postoperative endometrial carcinoma. Preliminary results. Brachytherapy. 2017;16:147–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Cortes S, Rovirosa A, Ascaso C, Sanchez J, Herreros A, Sola J, et al. Three short fractionation schedules for exclusive HDR-brachytherapy in endometrial carcinoma. Clin Transl Oncol. 2017;19(Extraordinary 1):100–1.Google Scholar
  16. 16.
    Cortes S, Rovirosa A, Ascaso C, Herreros A, Sanchez J, Huguet A, et al. Comparison of three short brachytherapy schedules after postoperative-external-beam-radiotherapy in endometrium. Clinical Transl Oncol. 2017;19(Extraordinary 1):24.Google Scholar
  17. 17.
    Rovirosa A, Cortes S, Ascaso C, Herreros A, Sanchez J, Arena M, et al. Results on vaginal relapse and toxicity of 3 192-Ir HDR brachytherapy schedules in postoperative endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2017;99(25, suppl. 2):E309.CrossRefGoogle Scholar
  18. 18.
    Charlson ME, Pompei P, Ales K, Mackenzie CR. A new method to classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373–83.CrossRefPubMedGoogle Scholar
  19. 19.
    Small W Jr, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71:428–34.CrossRefPubMedGoogle Scholar
  20. 20.
    Late effects consensus conference RTOG/EORTC. Radiother Oncol. 1995;35:5–7.Google Scholar
  21. 21.
    LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Phys. 1995;31:1049–1191.Google Scholar
  22. 22.
    Laroca A, Palumbo A. How I treat fragile myeloma patients. Blood. 2015;126(19):2179–85.CrossRefGoogle Scholar
  23. 23.
    Wiltink LM, Nout RA, Fiocco M, Meershoek-Klein Kranenbarg E, Jürgenliemk-Schulz IM, Jobsen JJ, et al. No increased risk of second cancer after radiotherapy in patients treated for rectal or endometrial cancer in the randomized TME, PORTEC-1, and PORTEC-2 trials. J Clin Oncol. 2015;33(15):1640–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Poupon C, Bendifallah S, Ouldamer L, Canlorbe G, Raimond E, Hudry N, et al. Management and survival of elderly and very elderly patients with endometrial cancer: an age-stratified study of 1228 women from the FRANCOGYN Group. Ann Surg Oncol. 2016.  https://doi.org/10.1245/s10434-016-5735-9.PubMedGoogle Scholar
  25. 25.
    Torgeson A, Boothe D, Poppe MM, Suneja G, Gaffney DK. Disparities in care for elderly women with endometrial cancer adversely effects survival. Gynecol Oncol. 2017;147(2):320–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Cortes KS, Glickman A, Valdes S, Cordova O, Ascaso C, Torne A, et al. Charlson comorbidity index in very elderly patients receiving postoperative radiotherapy for endometrial cancer treatment. Radiother Oncol. 2018;127(Suppl):S424.Google Scholar

Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2018

Authors and Affiliations

  1. 1.Radiation Oncology DepartmentHospital Clínic UniversitariBarcelonaSpain
  2. 2.Gynecological Cancer UnitHospital Clínic UniversitariBarcelonaSpain
  3. 3.Health Department, Faculty of MedicineUniversity of BarcelonaBarcelonaSpain
  4. 4.Economics DepartmentHospital Clinic UniversitariBarcelonaSpain
  5. 5.Fonaments Clinics, Faculty of MedicineUniversity of BarcelonaBarcelonaSpain
  6. 6.Radiation Oncology DepartmentHospital General de AlbaceteAlbaceteSpain
  7. 7.Radiation Oncology DepartmentHospital Sant Joan de ReusReusSpain

Personalised recommendations