PROGNOSTIC FACTORS AND TREATMENT OF CERVICAL CANCER (CC) IN ELDERLY

Abstract

Background Cancer diagnostics in the elderly is increasing over the years. Although elderly represent less than 10% of CC patients (pts), they usually present more advanced disease and do't receive aggressive treatment. Methods Retrospective analysis of pts ≥ 70 years old with CC consecutively admitted at single institution from Aug/2002 up to Feb/2012. Primary endpoint was overall survival (OS). Secondary endpoint was assessment of prognostic factors for OS and treatment received. Survival was estimated using the Kaplan-Meier methods, the curves were compared by the log-rank test and frequencies with chi-square test. Results 70 pts were analyzed (7.5% of all CC pts). Median age was 76 years old (range, 70-91y). Squamous carcinoma was the most common histological type (61 pts, 87.1%), 57 (81.4%) were performance status (PS) 0 or 1 and 37 (52.5%) were eutrophic (Body Mass Index 18.5- 25 Kg/m2). In terms of initial staging, 14 pts (20%) were stage I, 30 pts (42.8%) II, 10 pts (14.2%) III, 14 pts (20%) IVa and 2 pts (2.8%) IVb. Regarding the treatment, 32 pts (45.7%) underwent chemoradiotherapy (CRT), 19 pts (27.1%) isolated radiotherapy (RT), 12 pts (17.1%) surgery and 7 pts (10%) best supportive care (BSC). Among CRT pts, 19 (59.3%) completed the full treatment (platinum-based chemotherapy administered for 6 weeks concomitantly with external radiotherapy in the pelvis, total dose of 45 Gy, and 4 inserts from 7 to 7.5 Gy of brachytherapy); 16 (50%) received cisplatin and 16 (50%) carboplatin. In a median follow up of 15.3 mo (range, 0.1- 79.8 mo), mean OS was 79.8 mo for all pts in this analysis. Hemoglobin level ≥ 10 mg/dL pretreatment correlated with better mOS (HR 0.10; IC95% 0.02 to 0.42; p = 0.002), while creatinine ≥ 1 mg/dL before the treatment (HR 8.1; IC95% 1.87 to 34.88; p = 0.005) was considered risk factor to mortality. Pts who received QRT, RT had better mOS (HR 0,18; IC 95% 0,06 to 0.54; p= 0.002). Age, PS, BMI and comorbidities (pneumopathy, cardiopathy, dementia) did't correlate with mOS. Conclusions CRT is feasible in the elderly. Pts submitted to QRT, RT had better survival than those who did not undergo treatment and age alone can not be used to decide the conduct. Pts at baseline with Hb < 10 mg/dL and kidney disfunction had a poor prognosis.