Feasibility Study of Pelvic Helical IMRT for Elderly Patients with Endometrial Cancer

Purpose: Standard treatment for early-stage endometrial cancer involves surgery (when possible) followed by brachytherapy or external-beam radiotherapy (EBRT) for high-risk tumors. EBRT is not without toxicity, meaning that it could be difficult to complete for elderly patients, who typically have decreased reserve and resistance to stressors. Patients and methods: Patients aged 70 and over treated between April 2009 and May 2013 for endometrial cancer and received IMRT (Intensity-Modulated Radiation Therapy) were included in this observational study. IMRT could be performed as adjuvant treatment or as an exclusive treatment for patients not amenable to surgery. The primary endpoints of this study were to assess the feasibility and toxicity of pelvic IMRT in this population. Secondary endpoints were to assess disease-specific survival, overall survival, and local control. Predictors of toxicity were also explored. Results: Forty seven consecutive patients were included in the analysis. Median age at diagnosis was 75 years (range, 70-89 years). Eleven patients were aged 80 years and older. Toxicities were found in thirty four patients (72%) during treatment. Among these, toxicity did not exceed grade 2 for 32 patients (68%). Two patients had a grade 3 toxicity (4%). Overall survival rates were 87% and 83% at 1 and 2 years, respectively. Six patients (12.8%) had a local relapse and nine others (19.1%) had distant relapse. Conclusions: Pelvic helical IMRT for patients aged 70 and older is feasible with full standard radiation doses, showing that age greater than 70 should not be considered as a reason not to perform optimal treatment.