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  • br Discussion br A study from Taiwan reviewed elderly cervical


    A study from Taiwan reviewed 138 elderly cervical cancer pa-tients ( 75 years of age) and 334 young patients (<60 years of age) who underwent definitive radiotherapy or CCRT. The median follow-up period for survivors was 60.6 months. With propensity 
    score matching based on FIGO stage, histology, Lovastatin node status, and treatment methods, a cohort of 99 pairs of patients was selected for comparison. The 5-year OS rates in young and elderly patients were 71.5% and 49.2% (p < 0.001), respectively. But, there
    Fig. 1. The overall survival (A), disease-free survival (B), and cancer-specific survival
    (C) of 64 pairs of patients with cervical cancer in the young group (<60 years old) and elderly group ( 70 years old) after propensity score matching.
    Table 4
    Grade 3 or greater chronic toxicities in young and elderly groups.
    Toxicities Young group
    Elderly group P
    N Percentage
    N Percentage
    was no difference in CSS, local failure, and distant failure between the two groups [11]. A study from the US enrolled 69 nonelderly cervical cancer patients (<65 years of age) and 27 elderly patients ( 65 years of age). Fewer elderly patients (56%) received concur-rent chemotherapy, compared with the nonelderly patients (78%, p ¼ 0.03). The elderly patients had worse OS (nonelderly: 60.1%, elderly: 44.4%, p ¼ 0.02) and similar CSS (nonelderly: 61.6%, elderly: 70.8%, p ¼ 0.38). Moreover, age was not an independent factor of OS in multivariate analysis (HR 1.66, 95% CI 0.85e3.23, p ¼ 0.13) [12]. In the present study, young and elderly patients were defined as less than 60 years of age and 70 years of age and older. Patients in the elderly group had less advanced disease (fewer patients with large tumor and the pelvic MLNs) and less aggressive treatment (fewer patients with adequate dose to point A and concurrent chemo-therapy). Multivariate analysis showed that age was an indepen-dent factor for OS, but it was not significant in predicting DFS and CSS. After propensity score matching, OS, DFS, and CSS were similar between the two groups. As patients in elderly group had more deaths due to noncancer causes, and the cancer-specific death was similar between the two groups, more deaths of noncancer causes might be the main reason for the worse OS in the elderly group before matching. The treatment outcomes of patients in the young group and the elderly group were similar. r> As reported previously, elderly patients were always treated less aggressively [3,5e7]. Similarly, compared with young patients, less elderly cervical cancer patients received concurrent chemotherapy when they were treated with definitive radiotherapy [11,12]. The irradiation dose delivered was also lower in elderly patients [11]. In our study, there were also fewer patients in the elderly group receiving concurrent chemotherapy and adequate radiation dose. The main reason for less aggressive treatment was comorbidity and weakness of elderly patients, which may influence the tolerance of treatment. In the study from Taiwan, 79 pairs of patients were selected for complication comparisons, with treatment method, cervix dose, ICBT dose, and cumulative biological equivalent dose of point A being matched. After matching, the cumulative grade 2 and greater proctitis and grade 3 and greater proctitis in the young and elderly groups were 39.7% and 17.2% (p ¼ 0.015), 18.1% and 6.2% (p ¼ 0.040), respectively. The incidences of grade 2 proctitis were not significantly different between the two groups [11]. In the study from the US, there was no significant difference in complication rates between young and elderly patients (p ¼ 0.61) [12]. Similar to the study from Taiwan, our study demonstrated that more elderly patients developed grade 3 or greater gastrointestinal toxicities. And, the incidences of grade 3 or greater toxicities were not significantly different between the two groups. Although more patients in the elderly group developed chronic toxicities, the incidence of grade 3 or greater toxicities was just 8.6%. The acute hematological toxicity was not significantly different between young and elderly groups, no matter for patients treated with definitive radiotherapy or CCRT. These indicate that elderly patients could tolerate definitive radiotherapy or CCRT very well.