Differences in the outcomes and complications between elderly and younger uterine cervical cancer patients treated by definitive radiotherapy — A propensity score-matched study

• Published in: Gynecologic oncology 2017-05, Vol.145 (2), p.277-283
• Main Authors: Wang, Yu-Ming, Wang, Chong-Jong, Fang, Fu-Min, Chen, Hui-Chun, Hsu, Hsuan-Chih, Huang, Yu-Jie, Wang, Chang-Yu, Huang, Eng-Yen
• Format: Article
• Language: English
• Subjects: Advanced-age; Age Factors; Aged; Brachytherapy - adverse effects; Cohort Studies; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Prognosis, complications; Propensity Score; Radiotherapy; Radiotherapy - adverse effects; Treatment Outcome; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - radiotherapy; Uterine cervix cancer
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2017.02.034

Abstract Purpose To evaluate the differences in the treatment outcomes and complications between elderly patients and younger patients with uterine cervical cancer (CxCa). Methods and materials From April 1993 to December 2007, 138 CxCa patients aged ≥ 75 years (Elderly group) and 334 CxCa patients aged < 60 years (Young group) who underwent definitive radiotherapy/chemoradiotherapy at our institution were reviewed. Two propensity score-matched cohorts of patients were selected from both age groups to evaluate the differences in the outcomes and complications. The overall survival (OS), cancer-specific survival (CSS), local failure (LF), distant failure (DF), late proctitis, and cystitis were compared between the age groups. Results The median follow-up time for survivors was 60.6 months. A cohort of 99 pairs of patients was selected for the outcome comparison; there was a significant difference in the 5-year OS between the Elderly and Young groups (49.2% and 71.5%, respectively; p < 0.001) but no differences in CSS, LF, and DF. Another cohort of 79 pairs of patients was selected for complication analysis. Significant differences between the Elderly and Young groups were observed in the 5-year cumulative grade 2 proctitis (39.7% and 17.2%, respectively; p = 0.015) and grade 3 proctitis (18.1% and 6.2%, respectively; p = 0.040). Conclusions Although OS was worse in the elderly patients, no differences were observed in CSS, LF, and DF. Meanwhile, elderly patients tended to have higher radiation-related proctitis than younger patients. A more conservative treatment strategy for elderly CxCa patients is reasonable in our future practice.