Abstract
PURPOSE: To evaluate the impact of age on treatment-related acute morbidity, on modifications of drug doses and radiotherapy and on disease-free and overall survival in non-elderly and elderly with high-risk cervical cancer treated with concurrent radiochemotherapy following laparoscopic surgery. METHODS: One hundred and two patients with high-risk FIGO I - IVA cervical cancer (77 non-elderly [< 60 years] and 25 elderly [≥ 60 years]) were treated by radical hysterectomy with lymphadenectomy (n = 91) and postoperative radiochemotherapy or radical radiochemotherapy alone after laparoscopic lymph node dissection (n = 11) patients received five to six cycles of cis-platin, 40 mg/sqm weekly, given concurrently to pelvic radiotherapy of 45-50.4 Gy in 5-6 weeks. Paraaortic radiotherapy with 45 Gy was performed when laparoscopic staging revealed paraaortic node metastases. Acute morbidity was prospectively scored weekly. Toxicity-related protocol violations (treatment breaks or dose reduction) were related with age, 5-year overall survival (OS) and progression-free survival (PFS) rates. RESULTS: Clinical stages and histologic subtypes were equally distributed. Grade 3/4 leukopenia, anemia, diarrhea and nausea occurred more frequently in the elderly. 16 (22%) non-elderly and 6 (25%) elderly needed a modification of drug dose. 10/77 (13%) non-elderly patients and 11/25 (44%) of the elderly needed an unscheduled treatment break (p = 0.002). OS and PFS were not different between age groups. The 5-year OS rate was 47 ± 6% for non-elderly patients and 45 ± 10% for the elderly. Patients with/without treatment breaks had a 5-year OS rate of 39 ± 11%/48 ± 6%. The 5-year PFS rate is 49 ± 6% for non-elderly patients and 47 ± 11% for the elderly. Patients with/without treatment breaks had a 5-year PFS probability of 50 ± 12%/48 ± 6%. FIGO stage retains its prognostic significance irrespective of age. CONCLUSIONS: Concurrent radiochemotherapy caused slightly higher acute toxicity with increasing age. Adjustment of treatment intensity was more frequent in the elderly but did not result in detrimental outcome figures.