Comparisons of survivals and toxicities between young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy

Objective: To compare the survivals and toxicities of young and elderly patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy (CCRT).

Materials and methods: Patients with cervical cancer treated with radiotherapy or CCRT between January 2010 and December 2015 in our institute were reviewed. A dose of 50.4 Gy in 28 fractions was delivered to the pelvis with intensity modulated radiation therapy. In addition, a dose of 30-36 Gy in 5-7 fractions was prescribed to point A with brachytherapy. Weekly cisplatin was the first-line regimen of concurrent chemotherapy. Comparisons were made between patients in the young group (<60 years) and those in the elderly group (≥70 years) with multivariate analysis and propensity score matching.

Results: There were 991 patients in the young group and 70 patients in the elderly group. The median follow-up period was 30.2 months. In multivariate analysis, age was an independent factor of overall survival (OS, hazard ratio, HR 1.99, p = 0.014), but it was not significant in predicting disease-free survival (DFS, HR 1.41, p = 0.179) and cancer-specific survival (CSS, HR 1.38, p = 0.332). After propensity score matching, 64 pairs of patients were selected. The 3-year OS, DFS, and CSS rates in the young and elderly groups were 86.5% and 73.9% (p = 0.280), 74.6% and 75.4% (p = 0.744), and 87.9% and 81.7% (p = 0.967), respectively. Significant differences between the young and elderly groups were observed in grade 3 and above chronic toxicities (2.9% and 8.6%, p = 0.027) and grade 3 and above chronic gastrointestinal toxicities (2.4% and 8.6%, p = 0.009).

Conclusion: After definitive radiotherapy or CCRT, the DFS and CSS of elderly patients with cervical cancer were similar to those in young patients. Elderly patients experienced more chronic toxicities than did young patients.