External beam radiotherapy for older people with endometrial cancer


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Cicely Cunningham1,Azmat Sadozye1,Rosie Harrand2,Nicholas Reed3,Kathryn Graham4
1Beatson West of Scotland Cancer Centre,2Beatson West of Scotland,3Beatson West of Scotland Cancer,4Beatson West of Scotland Cancer Cent

Abstract

Background

Endometrial cancer is largely a disease of older women. The incidence is increasing and age is a significant prognostic factor, which has important resource implications. It is unclear whether poorer outcomes are due to more advanced disease/higher grade at presentation or suboptimal treatment. Population studies certainly indicate that older women are often managed with less aggressive surgery, and are less likely to be offered adjuvant radiation and/or chemotherapy. We performed a retrospective audit of patients ≥70 years who received radical dose external beam radiotherapy (EBRT) for endometrial cancer, inclusive of adjuvant, primary, or vault/pelvic recurrence treatment.

Method

We interrogated the radiotherapy management system to identify patients ≥70 years who commenced EBRT for endometrial cancer between January 2010 and December 2015. Clinicopathological data was extracted from corresponding medical records and date and cause of death obtained from the UK Death Registry.

Results

93 patients were identified. Median age was 75 years (range 70-90); 28% ≥80 years. 30% of tumours were confined to the uterus, >50% were locally advanced, and <20% were recurrences. Over 25% had aggressive Type 2 pathology.

83 patients completed all planned radiotherapy treatment (median EBRT dose 4500cGy/25#). 5 patients failed to complete EBRT, and 5 completed EBRT but discontinued brachytherapy. 4 women died within 30 days of terminating treatment.

Median overall survival (OS) was 61 months; 2-year and 5-year OS were 70% and 50%, respectively. Enhanced OS was associated with early stage, low grade, and adjuvant as opposed to primary treatment. Importantly, OS was significantly worse in women ≥80 years (23 months) compared to 70-79 years (76 months) (log rank, p=0.013).

Conclusion

Most patients ≥70 years tolerate EBRT. However, in women ≥80 years it may be appropriate to adopt a more pragmatic approach to treating their cancers, especially in the presence of advanced and/or high-grade disease.