Radiation Therapy in Geriatric Oncology

  • Sarah E. Hoffe
  • Mark S. Russell

Personalizing a patient’s course of cancer therapy is of utmost relevance to the geriatric population. Advances in diagnostic radiology and radiation technology have improved tolerability for this group and expanded treatment options. Better images to visualize the tumor with PET/CT or MRI can be registered to the CT data acquired with the patient in the treatment position so that a fused image of the tumor can be created. Radiation oncologists then contour the intended target and adjacent normal tissues on axial CT slices. By displaying these structures in three dimensions and even being able to see the effects of respiration (4D CT), a treatment plan can be generated that will optimize the balance between target versus normal tissue dose. Graphs called dose-volume histograms (DVHs) are formed to evaluate what dose a volume of a structure within the radiation field is receiving in the proposed treatment plan. This allows the physician to then decide which technique would be most feasible in that particular patient’s case.


Stereotactic Body Radiation Therapy Accelerate Partial Breast Irradiation Biologically Effective Dose Memorial Sloan Kettering Cancer Center Stereotactic Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Green N, Melbye RW, Lipsett J, Kurohara SS, George FW, 3rd, Cosgrove M. Prostate cancer: Measures to improve therapeutic response and prevent complications. Urology 1975;6(3) 287–90.PubMedCrossRefGoogle Scholar
  2. 2.
    Leibel SA, Hanks GE, Kramer S. Patterns of care outcome studies: Results of the national practice in adenocarcinoma of the prostate. Int J Radiat Oncol Biol Phys 1984;10 (3):401–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Pilepich MV, Krall J, George FW, Asbell SO, Plenk HD. Treatment related morbidity in phase III RTOG studies of extended field radiation therapy for carcinoma of the prostate. Int J Radiat Oncol Biol Phys 1984;10 (10):1861–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Dearnaley DP, Khoo VS, Norman AR, Meyer L, Nanum A, et al. Comparison of radiation side-effects of conformal radiation and conventional radiation in prostate cancer: A randomized trial. Lancet 1999;353 (9149):267–72.Google Scholar
  5. 5.
    NIH Consensus Development Panel Consensus Statement: The management of clinically localized prostate cancer. NCI monograph 1988;7:3–6.Google Scholar
  6. 6.
    Leibel SA, Heimann R, Kutcher GJ, Zelefsky MJ, Burman CM. Three dimensional conformal radiation therapy in locally advanced cancer of the prostate: Preliminary results of a phase I dose escalation study. Int J Radiat Oncol Biol Phys 1994;28 (1):55–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, et al. Dose escalation with three dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998;41 (3):491–500.PubMedCrossRefGoogle Scholar
  8. 8.
    Kuban DA, Tucker SL, Dong L, Starkschall G, Huang EH, Cheung MR, Lee AK, Pollack A. Long-term results of the MD Anderson dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008;70 (1):67–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Slater JD, Yonemoto LT, Rossi CJ, Reyes-Molyneux NJ, Bush DA. Conformal proton therapy for prostate cancer. Int J Radiat Oncol Biol Phys 1998; 42(2):299–304.PubMedCrossRefGoogle Scholar
  10. 10.
    Paschkis R, Tittinger W. Radiumbehandlung eines prostatasarkoms. Weiner klische Wochenschrift NR. 1910, p. 48.Google Scholar
  11. 11.
    Grimm PD, Blasko JC, Sylvester JE, Meier RM, Cavanagh W. 10-year biochemical (prostate specific antigen) control of prostate cancer with (125) I brachytherapy. Int J Radiat Oncol Biol Phys 2001;51 NR (1):31–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Sylvester JE, Grimm PD, Blasko JC, Millar JC, et al. 15-year biochemical relapse free survival in clinical stage T1-3 prostate cancer following combined external beam radiation therapy and brachytherapy: The Seattle experience. Int J Radiat Oncol Biol Phys 2007:67 NR (1):57–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Zelefsky MJ, Kuban DA, Levy LB, Potters L, Beyer DC. Multi-institutional analysis of long-term outcome for stages T1-2 prostate cancer treated with permanent seed implant. Int J Radiat Oncol Biol Phys 2007;67 NR (2):327–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Merrick GS, Butler WM, Wallner KE, Galbreath RW, Allen ZA, Gutman S, Lief J. Long-term rectal function after permanent prostate brachytherapy. Cancer J 2007;13 NR (2):95–104.PubMedCrossRefGoogle Scholar
  15. 15.
    Duchesne GM, Williams SG, Das R, Tai KH. Patterns of toxicity following high dose-rate brachytherapy boost for prostate cancer: Mature prospective phase I/II study results. Radiother Oncol 2007;84 NR (2):128–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Chen J, Lee RJ, Handrahan D, Sause WT. Intensity-modulated radiation therapy using implanted fiducial markers with daily portal imaging: Assessment of prostate organ motion. Int J Radiat Oncol Biol Phys 2007;68(3):912–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Sterzing F, Schubert K, Sroka-Perez G, Kalz J, Debus J, Herfarth K. Helical tomotherapy. Experiences of the first 150 patients in Heidelberg. Strahlenther Onkol 2008;184 (1):8–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Chang BK, Timmerman RD. Stereotactic body radiation therapy: A comprehensive review. Am J Clin Oncol 2007;30 (6):637–44.PubMedCrossRefGoogle Scholar
  19. 19.
    Fuller DB, Naitoh J, Lee C, Hardy S, Jin H. Virtual HDR cyberknife treatment for localized prostatic cancer: Dosimetry comparisons with HDR brachytherapy and preliminary clinical observations. Int J Radiat Oncol Biol Phys 2008;70 (5):1588–97.PubMedCrossRefGoogle Scholar
  20. 20.
    Fisher B, Jeong JH, Anderson S, Bryant J, Fisher ER, Wolmark N. Twenty-five year follow-up of a randomized trial comparing radical mastectomy, total mastectomy and total mastectomy followed by irradiation. N Engl J Med 2002;347 (8):567–75.PubMedCrossRefGoogle Scholar
  21. 21.
    Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002;347 (16):1233–41.PubMedCrossRefGoogle Scholar
  22. 22.
    Overgaard M, Jensen MB, Overgaared J, Hansen PS, Rose C, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomized trial. Lancet 1999;353 (9165):1641–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Smith BD, Haffty BG, Smith GL, Hurria A, Buchholz TA, et. al. Use of postmastectomy radiotherapy in older women. Int J Radiat Oncol Biol Phys 2008;71:98–106.PubMedCrossRefGoogle Scholar
  24. 24.
    Harris EE, Correa C, Hwang WT, Liao J, Litt HI, Ferrari VA, Solin LJ. Late cardiac mortality and morbidity in early stage breast cancer patients after breast conserving therapy. J Clin Oncol 2006;24 (25):4100–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Patt DA, Goodwin JS, Kuo YF, Freeman JL, Zhang DD, et al. Cardiac morbidity of adjuvant radiotherapy for breast cancer. J Clin Oncol 23:7475–82.Google Scholar
  26. 26.
    Harris EE, Hwang WT, Urtishak SL, Plastaras J, Kinosian B, Solin LJ. The impact of comorbidities on outcomes for elderly women treated with breast conservation therapy for early stage breast cancer. Int J Radiat Oncol Biol Phys 2008;70 (5):1453–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, et al. Lumpectomy plus tamoxifen with or without irradiation in women of 70 years of age or older with early breast Cancer. N Engl J Med 2004;351:971–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W. A multicenter randomized trial of breast IMRT to reduce acute radiation dermatitis. J Clin Oncol 2008;26 (13):2085–92.PubMedCrossRefGoogle Scholar
  29. 29.
    Hong L, Hunt M, Chui C, Spirou S, Forster K, et al. Intensity-modulated tangential beam irradiation of the intact breast. Int J Radiat Oncol Biol Phys 1999;44 (5):1155–64.PubMedCrossRefGoogle Scholar
  30. 30.
    Korreman SS, Pedersen AN, Aarup LR, Nottrup TJ, Specht L, Nystrom H. Reduction of cardiac and pulmonary complication probabilities after breathing adapted radiation therapy for breast cancer. Int J Radiat Oncol Biol Phys 2006;65 (5):1375–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Korreman SS, Pedersen AN, Nottrup TJ, Specht L, Nystrom H. Breathing adapted radiotherapy for breast cancer: Comparison of free breathing gating with the breath hold technique. Radiother Oncol 2005;76 (3):311–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Stegman LD, Beal KP, Hunt MA, Fornier MN, Mccormick B. Long-term clinical outcomes of whole-breast irradiation delivered in the prone position. Int J Radiat Oncol Biol Phys 2007;68 (1):73–81.Google Scholar
  33. 33.
    Whelan T, Mcckenzie R, Julian J, Levine M, Shelley W. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node negative breast cancer. J Natl Cancer Inst 2002;94 (15):1143–50.PubMedCrossRefGoogle Scholar
  34. 34.
    Whelan T. ASTRO update, Plenary session, Sep 2008.Google Scholar
  35. 35.
    Swanson TA, Vicini FA. Overview of accelerated partial breast irradiation. Curr Oncol Rep 2008;10 (1):54–60.PubMedCrossRefGoogle Scholar
  36. 36.
    Kraus-Tiefenbacher U, Scheda A, Steil V, Hermann B, Kehrer T, et al. Intraoperative radiotherapy (IORT) for breast cancer using the Intrabeam system. Tumori 2005;91 (4):339–45.PubMedGoogle Scholar
  37. 37.
    Dirbas FM, Jeffrey SS, Goffinet DR. The evolution of accelerated, partial breast irradiation as a potential treatment option for women with newly diagnosed breast cancer considering breast conservation. Cancer Biother Radiopharm 2004;19 (6):673–705.PubMedCrossRefGoogle Scholar
  38. 38.
    King TA, Bolton JS, Kuske RR, et al. Long-term results of wide-field brachytherapy as the sole method of radiotherapy after segmental mastectomy for T(is, 1,2) breast cancer. Am J Surg 2000;180:299–304.PubMedCrossRefGoogle Scholar
  39. 39.
    Benitez PR, Keisch ME, Vicini F, Stolier A, Scroggins T, et al. Five-year results: The initial clinical trial of Mammosite balloon brachytherapy for partial breast irradiation in early stage breast cancer. Am J Surg 2007;194 (4):456–62.PubMedCrossRefGoogle Scholar
  40. 40.
    Formenti SC, Truong MT, Goldberg JD, Mukhi V, Rosenstein B. Prone accelerated partial breast irradiation after breast-conserving surgery: Preliminary clinical results and dose-volume histogram analysis. Int J Radiat Oncol Biol Phys 2004;60 (2):493–504.PubMedCrossRefGoogle Scholar
  41. 41.
    Patel RR, Becker SJ, Das RK, Mackie TR. A dosimetric comparison of accelerated partial breast irradiation techniques: Multicatheter interstitial brachytherapy, 3D conformal radiotherapy, and supine vs. prone helical tomotherapy. Int J Radiat Oncol Biol Phys 2007;68 (3):935–42.PubMedCrossRefGoogle Scholar
  42. 42.
    Heron DE, Andrade RS, Beriwal S, Smith RP. PET-CT in radiation oncology: The impact on diagnosis, treatment planning, and assessment of treatment response. Am J Clin Oncol 2008;31 (4):352–62.PubMedCrossRefGoogle Scholar
  43. 43.
    Erdi Ye, Rosenzweig K, Erdi AK, Macapinlac HA, Hu YC, et al. Radiotherapy treatment planning for patients with non-small cell lung carcinoma using PET. Radiother Oncol 2002;62 (1):51–60.PubMedCrossRefGoogle Scholar
  44. 44.
    Bradley J, Thorstad WL, Mutic S, Miller TR, Dehdashti F, et al. Impact of FDG-PET on radiation therapy volume delineation in non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys 2004;59 (1):78–86.PubMedCrossRefGoogle Scholar
  45. 45.
    Rosenzweig KE, Sura S, Jackson A, Yorke E. Involved-field radiotherapy for inoperable non-small cell lung carcinoma. J Clin Oncol 2007:25 (35):5557–61.PubMedCrossRefGoogle Scholar
  46. 46.
    Yu HM, Liu YF, Yu JM, Liu J, Zhao Y, Hou M. Involved-field radiotherapy is effective for patients 70 years old or more with early stage non-small cell lung carcinoma. Radiother Oncol 2008;87 (1):29–34.PubMedCrossRefGoogle Scholar
  47. 47.
    Dosoretz DE, Katin MJ, Blitzer PH, Rubenstein JH, Salenius S, et al. Radiotherapy in the management of medically inoperable carcinoma of the lung: Results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 1992;24 (1):3–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Urbanic JJ, Turrisi AT, Sharma AK, Silvestri GA, Williams TE, et al. Conformal high dose external radiotherapy, 80.5 Gy, alone for medically inoperable non-small cell lung carcinoma: A retrospective analysis. J Thorac Oncol 2006;1 (2):112–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Bradley J, Graham MV, Winter K, Purdy JA, Komaki R, et al. Toxicity and outcome results of RTOG 93-11: A phase I-II dose escalation study using three-dimensional conformal radiotherapy in patients with medically inoperable non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2005;61 (2):318–28.PubMedCrossRefGoogle Scholar
  50. 50.
    Werner-Wasik M, Swann RS, Bradley J, Graham M, Emami B, et al. Increasing tumor volume is predictive of poor overall and progression free survival: Secondary analysis of the RTOG 93-11 phase I-II radiation dose-escalation study in patients with non-small cell lung carcinoma. Int J Radiat Oncol Biol Phys 2008;70 (2):385–90.PubMedCrossRefGoogle Scholar
  51. 51.
    Blomgren H, Lax I, Naslund I, Svanstrom R. Stereotactic high dose fraction radiotherapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol 1995;34 (6):861–70.PubMedCrossRefGoogle Scholar
  52. 52.
    Timmerman RD, Kavanagh BD, Cho LC, Papiez L, Xing L. Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol 2007;25 (8):947–52.PubMedCrossRefGoogle Scholar
  53. 53.
    Lo SS, Fakiris AJ, Papiez L, Abdulrahman R, McGarry RC, et al. Stereotactic body radiotherapy for early stage non-small cell lung cancer. Expert Rev Anticancer Ther 2008:8 (11):87–98.PubMedCrossRefGoogle Scholar
  54. 54.
    Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, et al. Hypofractionated stereotactic radiation therapy (HypoFXSRT) for stage I non small cell lung carcinoma: Updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007;2 (7 Suppl 3):S94–100.PubMedCrossRefGoogle Scholar
  55. 55.
    McGarry RC, Papiez L, Williams M, Whitford T, Timmerman RD. Stereotactic body radiotherapy of early-stage non-small-cell lung cancer: Phase I study. Int J Radiat Oncol Biol Phys 2005;63 (4):1010–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Chang JY, Zhang X, Wang X, Kang Y, Riley B. Significant reduction of normal tissue dose by proton raditotherapy compared with 3D conformal radiotherapy or IMRT in stage I or III non small cell lung carcinoma. Int J Radiat Oncol Biol Phys 2006;65 (4):1087–96.PubMedCrossRefGoogle Scholar
  57. 57.
    Hata M, Tokuuye K, Kagei K, Sugahara S, Nakayama H. Hypofractionated high-dose proton beam therapy for stage I non small cell lung cancer: Preliminary results of a phase I/II clinical study. Int J Radiat Oncol Biol Phys 2007;68 (3):786–93.PubMedCrossRefGoogle Scholar
  58. 58.
    Shioyama Y, Tokuuye K, Okumura T, Kagei K, Sugahara S, Ohara K. Clinical evaluation of proton radiotherapy for non-small cell lung cancer 1983–2000. Int J Radiat Oncol Biol Phys 2003;56 (1):7–13.PubMedCrossRefGoogle Scholar
  59. 59.
    Fong Y, Fortner J, Sun RL, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15:938–46.PubMedGoogle Scholar
  60. 60.
    Aloia TA, Vauthey JN, Loyer EM, et al. Solitary colorectal liver metastasis: Resection determines outcome. Arch Surg 2006;141:460–7.PubMedCrossRefGoogle Scholar
  61. 61.
    Tan KY, Kawamura Y, Mizokami K, Sasaki J, Tsujinaka S, et al. Colorectal surgery in octogenarian patients—Outcomes and predictors of morbidity. Int J Colorectal Dis 2008 [Epub ahead of print].Google Scholar
  62. 62.
    Robertson JM, Lawrence TS, Walker S, et al. The treatment of colorectal liver metastasis with conformal radiation therapy and regional chemotherapy. Int J Radiat Oncol Biol Phys 1995;32:445–50.PubMedCrossRefGoogle Scholar
  63. 63.
    Dawson LA, Normolle D, Balter JM, et al. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 2002;53:810–21.PubMedCrossRefGoogle Scholar
  64. 64.
    Herfarth KK, Debus J, Lohr F, et al. Stereotactic single-dose radiation therapy of liver tumors: Results of a phase I/II trial. J Clin Oncol 2001;19:164–70.PubMedGoogle Scholar
  65. 65.
    Shefter TE, Kavanagh BD, Timmerman RD, et al. A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys 2005;62:1371–8.CrossRefGoogle Scholar
  66. 66.
    Katz AW, Carey-Sampson M, Muhs AG, et al. Hypofractionated stereotactic body radiation therapy (SBRT) for limited hepatic metastases. Int J Radiat Oncol Biol Phys 2007;67:793–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Tse R, Hawkins M, Lockwood G, Kim J, Cummings B, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 2008;26:657–64.PubMedCrossRefGoogle Scholar
  68. 68.
    Khodjibekova M, Szyszko T, Khan S, Nijran K, Tait P, Al-Nahhas A. Selective internal radiation therapy with Yttrium-90 for unresectable liver tumours. Rev Recent Clin Trials Sep 2007;2:212–6.CrossRefGoogle Scholar
  69. 69.
    Koong AC, Le QT, Ho A, et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;58:1017–21.PubMedCrossRefGoogle Scholar
  70. 70.
    Farma JM, Santillan AA, Melis M, Walters J, et al. PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol 2008;15:2465–71.PubMedCrossRefGoogle Scholar
  71. 71.
    Leong T, Everitt C, Yuen K, Condron S, Hui A, et al. A prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Radiother Oncol 2006;78:254–61.PubMedCrossRefGoogle Scholar
  72. 72.
    Wang SL, Liao Z, Vaporciyan AA, Tucker SL, Liu H, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys 2006;64:692–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Ehler W, Nelms B, Tome W. On the dose to a moving target while employing different IMRT delivery mechanisms. Radiother Oncol 2007;83:49–56.PubMedCrossRefGoogle Scholar
  74. 74.
    Bazan JG, Hara W, Hsu A, Pawlicki T, Koong AC, et al. Conventional versus intensity-modulated radiation therapy for anal cancer: A clinical comparison. Proc GI ASCO 2008;476.Google Scholar
  75. 75.
    Salama J, Mell L, Schomas D, Miller R, Devisetty K, et al. Concurrent chemotherapy and intensity-modulated radiation therapy for anal cancer patients: A multicenter experience. J Clin Oncol 2007;25:4581–6.PubMedCrossRefGoogle Scholar
  76. 76.
    De Ridder M, Tournel K, Van Nieuwenhove Y, Engels B, Hoorens A, et al. Phase II study of preoperative helical tomotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2008;70:728–34.PubMedCrossRefGoogle Scholar
  77. 77.
    Ongoing RTOG 0822 clinical trial: A phase II evaluation of preoperative chemoradiotherapy utilizing intensity modulated radiation therapy (IMRT) in combination with capecitabine and oxaliplatin for patients with locally advanced rectal cancer.Google Scholar
  78. 78.
    Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C. Preoperative vs. postoperative chemoradiotherapy for rectal cancer. N Eng J Med 2004;351:1731–40.CrossRefGoogle Scholar
  79. 79.
    Vuong T, Devic S, Podgorsak E. High dose rate endorectal brachytherapy as a neoadjuvant treatment for patients with resectable rectal cancer. Clin Oncol 2007;19:701–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Assistant Member, Radiation OncologyH. Lee Moffitt Cancer Center and Research InstituteTampaUSA

Personalised recommendations