Patterns of care of cervical cancer in the elderly: A qualitative literature review.
Cancer of the uterine cervix is the fourth most common cancer worldwide among women. However, there is limited data about elderly patients with cervical cancer and gross underrepresentation of elderly patients in clinical trials. Hence, the optimal therapy of such patients is not well formulated.



We conducted this systematic review of evidence to assess patterns of care in elderly patients with cervical cancer.



A total of 17,338 publications are reported in PubMed until July, 2016 pertaining to cervical cancer. Out of these, only 24 publications (full length papers or meeting proceedings) reported about clinical outcomes of elderly patients with cervical carcinoma. These publications report data from as early as 1949 to the present. In these publications, out of 14,479 patients aged ≥60years of age, 11,279 (77.89%) received external beam radiation. Concurrent chemotherapy has been used in 11 publications. Brachytherapy usage has been reported in 19 publications. In a few studies, brachytherapy was not used because of fear of toxicity. Overall, low dose rate (LDR) was the most common modality, followed by high dose rate (HDR). The authors have showed technical reasons (48.7%), comorbidities (69.4%) and patient refusal (38.3%) as causes for not delivering brachytherapy. Five-year overall survival (OS) has been found to be inferior to the non-elderly cohort and ranges from 27%-69% for elderly patients compared to 58%-75% in the non-elderly population. An 11% 5year OS has been reported for patients treated with suboptimal radiation dose compared to 74% in those treated with chemo radiotherapy followed by brachytherapy.



Gross underrepresentation of patients above 65years in clinical trials has resulted in treatment dilemmas in the elderly. Newer advances like immunotherapy, hypoxic modifiers, image guided radiation, image guided brachytherapy are promising approaches to reduce treatment complications and optimize outcome in elderly patients in cervical cancer.
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi.
Bhanu Prasad
BP
Venkatesulu
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi. Electronic address: drsupriyamallick@gmail.com.
Supriya
S
Mallick
Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi.
Goura K
GK
Rath
D000367:Age Factors; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008495:Medical Oncology / Q000379:methods*; D009367:Neoplasm Staging; D036301:Qualitative Research; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000628:therapy*
Cervix; Chemotherapy; Elderly; Pattern of care; Radiotherapy; Surgery