Therapeutic choices in cancer of the elderly.
Pathologies related to aging, including cancer, became of greater social and medical importance. The first dilemma is whether to treat elderly cancer patients and perform antitumoral therapy. Surgery is the first approach in tumors regardless of age, but a chemotherapy protocol must also be programmed to prepare the patient to surgical removal and reduce the size of the tumour. Radiotherapy is efficacious to treat many malignancies and in pain relief in advanced stages of the disease. Regarding medical therapy, different administration strategies can be adopted in the elderly. The use of high doses of antitumoral drugs achieves the highest number of objective responses, but may cause severe toxic side effects necessitating suspension of treatment. In the patients presenting good initial conditions, the dose intensity strategy is the most suitable. Targeted strategy can be defined as an alternative strategy where the patient receives drug over a longer period in function of the symptoms heralding recurrence. Low dose strategy is based on uninterrupted administration of one or more drugs at lower doses, regardless of the disappearance of persistence of the main symptoms of the disease. In situations calling for only palliative treatment, support therapy seems to be the best strategy. Furthermore, immunotherapy with interleukin-2 and/or interferons seems to demonstrate a great efficacy in solid tumors and malignancies of the blood. In conclusion, treatment of cancer in the elderly is similar to that applied to adults. Moreover, a less aggressive strategy seems achieve adequate quality of life for the remaining years.
Malaguarnera
M
M
Institute of Internal Medicine and Geriatrics, University of Catania, Cannizzaro Hospital, Via Messina, 829, l-95126 Catania, Italy.