Outcomes and tolerability of chemoradiation therapy for pancreatic cancer patients aged 75 years or older.
OBJECTIVE
To review the outcomes and tolerability of full-dose chemoradiation in elderly patients aged 75 years or older with localized pancreatic cancer.


METHODS
We retrospectively reviewed patients aged 75 years or older with nonmetastatic pancreatic cancer treated with chemoradiation therapy at two institutions from 2002 to 2007. Patients were analyzed for treatment toxicity, local recurrences, distant metastases, and survival.


RESULTS
A total of 42 patients with a median age of 78 years (range, 75-90 years) who received chemoradiation therapy for pancreatic cancer were identified. Of the patients, 24 had locally advanced disease treated with definitive chemoradiation, and 18 had disease treated with surgery and chemoradiation. Before chemoradiotherapy, the mean Eastern Cooperative Oncology Group performance status was 1.0 +/- 0.8, and the mean 6-month weight loss was 5.3 +/- 3.8 kg. The mean radiation dose delivered was 48.1 +/- 9.2 Gy. All patients received fluoropyrimidine-based chemotherapy concurrently with radiotherapy. In all, 8 patients (19%) were hospitalized, 7 (17%) had an emergency room visit, 15 (36%) required a radiation treatment break, 3 (7%) required a chemotherapy break, 9 (21%) did not complete therapy, and 22 (49%) had at least one of these adverse events. The most common toxicities were nausea, pain, and failure to thrive. Median overall survival was 8.6 months (95% confidence interval, 7.2-13.1) in patients who received definitive chemoradiation therapy and 20.6 months (95% confidence interval, 9.5-infinity) in patients who underwent resection and chemoradiation therapy.


CONCLUSIONS
In this dataset of very elderly patients with pancreatic cancer and good Eastern Cooperative Oncology Group performance status, outcomes after chemoradiotherapy were similar to those among historic controls for patients with locally advanced and resected pancreatic cancer, although many patients experienced substantial treatment-related toxicity.
Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA.
David T
DT
Miyamoto
Harvey J
HJ
Mamon
David P
DP
Ryan
Christopher G
CG
Willett
Marek
M
Ancukiewicz
Wendy K
WK
Kobayashi
Lawrence
L
Blaszkowsky
Carlos
C
Fernandez-del Castillo
Theodore S
TS
Hong
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D005183:Failure to Thrive; D005260:Female; D006801:Humans; D008297:Male; D009325:Nausea / Q000209:etiology; D009367:Neoplasm Staging; D010146:Pain / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology