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European Society for Medical Oncology (ESMO) Asia 2016 Congress

Brachytherapy may improve treatment outcomes in elderly cervical cancer patients

2017-01-23


Incorporating brachytherapy in standard treatment protocols for elderly cervical cancer patients has the potential to improve treatment outcomes, according to a review study presented at the European Society for Medical Oncology (ESMO) Asia 2016 Congress held in Singapore.

Use of brachytherapy as a treatment modality for cervical cancer in the elderly has been documented in several studies. However, optimal usage is not well formulated due to limited data and underrepresentation of the elderly population in clinical trials, according to the researchers from All India Institute of Medical Sciences in New Delhi, India. [Int J Gerontol 2016;doi:10.1016/j.jgo.2016.12.004]

Five-year overall survival (OS) rate for elderly patients treated with brachytherapy following chemoradiotherapy was at 74 percent, and compared with suboptimal radiation dose was at 11 percent. [Int J Gerontol 2011;doi:10.1016/j.ijge.2011.04.012; ESMO Asia 2016, abstract 3O6PD]

“Results [have shown] a possibility of achieving equivalent or near equivalent results even in elderly patients [with an] adequate dose of radiation along with chemotherapy followed by radiation,” said the researchers.

A previous analysis showed inferior OS when brachytherapy was replaced with itensity modulated radiation therapy or stereotactic boost (hazard ratio [HR], 1.86, 95 percent confidence interval [CI], 1.35?2.55; p<0.01). [Int J Radiat Oncol Biol Phys 2014;90:1083-1090]

The researchers also noted the presence of comorbidities to be the primary reason (69.4 percent) for not delivering brachytherapy, followed by technical reasons and patient refusal (48.7 percent and 38.3 percent, respectively). Furthermore, previous studies have also noted a decline in brachytherapy usage as patient age increases. [Cancer 2012;118:3618-3626; Gynecol Oncol 1998;71:291-298]

Some studies referred to a fear of toxicity as a reason for not administering brachytherapy. “[However], brachytherapy should be a part of the standard of care for elderly cervical cancers,” they said, highlighting several advantages of integrating brachytherapy in standard treatment measures.

Given its potential in improving treatment outcomes, brachytherapy plays an integral role in early treatment as well as in advanced stages of cervical cancer. “Newer advances… [such as] image-guided brachytherapy are promising approaches to reduce treatment complications and optimize outcome in elderly patients in cervical cancer,” the researchers said.
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