title: How well do elderly patients with cervical cancer tolerate definitive radiochemotherapy using RapidArc? Results from an institutional audit comparing elderly versus younger patients.
abstract: OBJECTIVE
  Elderly patients (65 or older) with cervical cancer often receive suboptimal radio-chemotherapy. Intensity-modulated radiotherapy (IMRT) may improve tolerance to treatment in this setting. This study was designed to compare the treatment-related toxicities and compliance with treatment in patients of cervical cancer treated definitively with RapidArc IMRT in our institute.
  
  
  METHODS
  The treatment records of all patients treated with RapidArc IMRT between April 2012 and April 2014 were reviewed, retrospectively. Prospectively collected data regarding treatment toxicity (CTCAE 4.0), treatment outcomes and parameters related to treatment compliance were compared amongst two age groups (< 65 and ≥ 65 years). The results of 66 patients were identified, of whom 23 were found to be ≥ 65 years age. All patients completed planned external beam radiotherapy. However, significantly fewer patients in the elderly group received concurrent chemoradiation (98% versus 65%, p < 0.001). Old age (median 75 years, IQR: 74-78 years) was the commonest cause for non-receipt of chemotherapy. Incidence of grade 3 haematological toxicities (26.7% versus 16.7%) and gastrointestinal toxicity (16.7% versus 13.3%) were not significantly different between the two groups. Other treatment-related toxicities, breaks, treatment duration and early outcomes were also not significantly different between the two age groups.
  
  
  CONCLUSIONS
  The use of IMRT did not result in excess toxicities in the elderly population and was associated with equivalent compliance to treatment. Concurrent chemoradiation can be safely combined in elderly patients with perfect organ function and performance status.
authors.affiliation: Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala 670103, India.
authors.forename: Santam
authors.initials: S
authors.lastname: Chakraborty
authors.affiliation: Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala 670103, India.
authors.forename: M
authors.initials: M
authors.lastname: Geetha
authors.affiliation: Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala 670103, India.
authors.forename: Sampada
authors.initials: S
authors.lastname: Dessai
authors.affiliation: Department of Clinical Hematology and Medical Oncology, Malabar Cancer Centre, Thalassery, Kerala 670103, India.
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Patil
keywords: aged; chemoradiation; intensity-modulated radiotherapy; toxicity; uterine cervical neoplasms