Review of current best practice and priorities for research in radiation oncology for elderly patients with cancer: the International Society of Geriatric Oncology (SIOG) task force
A partir d'une revue de la littérature publiée entre janvier 1990 et octobre 2013 (91 articles), cet article fait le point sur l'utilisation et l'efficacité de différentes modalités de radiothérapie chez les patients âgés atteints d'un cancer, et résume les priorités en matière de recherche
Radiotherapy (RT) is a key component of the management of older cancer patients. Level I evidence in older patients is limited. The International Society of Geriatric Oncology (SIOG) established a task force to make recommendations for curative radiotherapy in older patients and to identify future research priorities. Evidence-based guidelines are provided for breast, lung, endometrial, prostate, rectal, pancreatic, oesophageal, head and neck, CNS malignancies and lymphomas. Patient selection should include comorbidity and geriatric evaluation. Advances in radiation planning and delivery improve target coverage, reduce toxicity and widen eligibility for treatment. Shorter courses of hypofractionated whole breast radiotherapy are safe and effective. Conformal radiotherapy and involved field techniques without elective nodal irradiation have improved outcomes in non-small cell lung cancer (NSCLC) without increasing toxicity. Where comorbidities preclude surgery, stereotactic body radiotherapy (SBRT) is an option for early stage NSCLC and pancreatic cancer. Modern involved field radiotherapy for lymphoma based on pretreatment PET data has reduced toxicity. Significant comorbidity is a relative contraindication to aggressive treatment in low-risk prostate cancer (PC). For intermediate-risk disease 4-6 months of hormones are combined with external beam radiotherapy (EBRT). For high-risk PC combined modality therapy is advised. For high-intermediate risk EMC vaginal brachytherapy is recommended. Short-course EBRT is an alternative to combined modality therapy in older patients with rectal cancer without significant comorbidities. Endorectal RT may be an option for early disease. For primary brain tumours shorter courses of postoperative radiotherapy following maximal debulking provide equivalent survival to longer schedules. MGMT methylation status may help select older patients for temozolomide alone. Stereotactic RT provides an alternative to whole-brain RT in patients with limited brain metastases. IMRT provides an excellent technique to reduce dose to the carotids in head and neck cancer and improves loco-regional control in oesophageal cancer. Best practice and research priorities are summarised.