Abstract

Background: Elderly patients treated with radiotherapy (RT) for advanced cervical cancer are more likely to suffer severe treatment-related toxicity due to underlying comorbidities. Severe toxicity may lead to treatment interruptions, reduced overall survival (OS), worse comorbidities, and poor quality of life.  Therefore, there is a need to optimize the treatment of these patients to improve clinical outcomes. This study aimed to identify the prognostic factors for survival and treatment-related toxicities in elderly cervical cancer patients treated with definitive RT.

Methods: From January 2005 to June 2012, 103 patients aged 75 years and older diagnosed with cervical cancer were enrolled in our study. The median age was 77 years. All patients were treated with both external beam radiotherapy (EBRT) and high dose rate intracavitary brachytherapy (HDR-ICBT). The OS rate was analyzed using the Kaplan-Meier method. Acute and chronic toxicity was evaluated during follow-up appointments using the Common Terminology Criteria for Adverse Events version 3.0. Univariate and multivariate analyses were used to identify the impact of patient comorbidities, tumor stage, and RT treatment on toxicity and survival.

Results: The patient follow-up rate was 92.23%. The one, three, and five-year OS rates were 96.1%, 67.2%, and 60.2%, respectively. None of the patients developed grade III or IV GI/GU toxicity during RT. Ten patients developed grade 2 or higher radiation proctitis. The univariate analysis showed that pelvic lymph node involvement with or without para-aortic lymph node metastasis (PLN ± PALN), primary tumor size, and radiation dose were the three main factors influencing OS, while the Chalson comorbidity disease score had no impact on OS. Following multivariate analysis, PLN ± PALN, primary tumor size, and radiation dose were identified as independent factors affecting long-term survival.

Conclusions: Definitive RT is well tolerated in elderly patients with multiple comorbidities.