We present preliminary data of the first older cancer patients treated with Hybrid Linac for stereotactic body radiotherapy (SBRT) consisting of 1.5 T MRI-guided and daily-adapted treatment. The aim was to assess feasibility, safety and the role of G8 and Charlson Comorbidity Index (CCI) questionnaires in predicting patients’ QoL, evaluated by patient-reported outcome measures (PROMs).
Two groups of patients with localized prostate cancer or abdominal-pelvic oligometastases were analyzed. SBRT schedule consisted of 35 Gy delivered in 5 fractions. The primary endpoint was to measure the impact of G8 and CCI on PROMs. Both G8 and the CCI were performed at baseline, while the EORTC Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for PROMs assessment was prospectively performed at baseline and after SBRT.
Forty older patients were analyzed. The median age was 73 years (range 65–85). For the entire population, the median G8 score was 15 (10–17) and the median CCI score was 6 (4–11). Concerning the PROMS, the EORTC-QLQ C30 questionnaire reported no difference between the pre- and post-SBRT evaluation in all patients, except for the fatigue item that declined after SBRT, especially in the group of patients with a G8 score < 15 and with age < 75 years (p = 0.049). No grade 3 or higher acute toxicity occurred.
This is the first report documenting for older cancer patients that 1.5 T MRI-guided daily-adapted SBRT is feasible, safe and does not impact on the QoL at the end of treatment. Longer follow-up is advocated to report long-term outcomes.
Date of approval April 2019 and numbered MRI/LINAC no. 23748.
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Alongi F, Fiorentino A, Mancosu P, Navarria P, Giaj Levra N, Mazzola R et al (2016) Stereotactic radiosurgery for intracranial metastases: Linac-based and gamma-dedicated unit approach. Expert Rev Anticancer Ther 16(7):731–740
Alongi F, Mazzola R, Fiorentino A, Corradini S, Aiello D, Figlia V et al (2019) Phase II study of accelerated Linac-based SBRT in five consecutive fractions for localized prostate cancer. Strahlenther Onkol 195(2):113–120. https://doi.org/10.1007/s00066-018-1338-7
De Bari B, Alongi F, Mortellaro G, Mazzola R, Schiappacasse L, Guckenberger M (2016) Spinal metastases: Is stereotactic body radiation therapy supported by evidences? Crit Rev Oncol Hematol 98:147–158
De Bari B, Arcangeli S, Ciardo D, Mazzola R, Alongi F, Russi EG, Santoni R, Magrini SM, Jereczek-Fossa BA, on the behalf of the Italian Association of Radiation Oncology (AIRO) (2016) Extreme hypofractionation for early prostate cancer: biology meets technology. Cancer Treat Rev 50:48–60
Birim O, Kappetein AP, Bogers AJ (2005) Charlson comorbidity index as a predictor of long-term outcome after surgery for non-small cell lung cancer. Eur J Cardiothorac Surg 28(5):759–762
Chargari C, Moriceau G, Auberdiac P, Guy JB, Assouline A, Tinquaut F, Falk AT, Eddekkaoui H, Bourmaud A, Coscas Y, Annede P, Rivoirard R, Mery B, Trone JC, Otmezguine Y, Pacaut C, Bauduceau O, Vedrine L, Merrouche Y, Magne N (2014) Feasibility of radiation therapy in patients 90years of age and older: a French multicentre analysis. Eur J Cancer 50(8):1490–1497. https://doi.org/10.1016/j.ejca.2014.02.012
Chiumento C, Fiorentino A, Cozzolino M, Caivano R, Clemente S, Pedicini P, Fusco V (2013) Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy. Chin J Cancer Res 25(3):274–280. https://doi.org/10.3978/j.issn.1000-9604.2013.06.06
Corradini S, Alongi F, Andratschke N, Belka C, Boldrini L, Cellini F et al (2019) MR-guidance in clinical reality: current treatment challenges and future perspectives. Radiat Oncol 14(1):92. https://doi.org/10.1186/s13014-019-1308-y
Cuccia F, Fiorentino A, Corrao S, Mortellaro G, Valenti V, Tripoli A, De Gregorio G, Serretta V, Verderame F, Ognibene L, Lo Casto A, Ferrera G (2019) Moderate hypofractionated helical tomotherapy for prostate cancer in a cohort of older patients: a mono-institutional report of toxicity and clinical outcomes. Aging Clin Exp Res. https://doi.org/10.1007/s40520-019-01243-1
Cuccia F, Mortellaro G, Mazzola R, Donofrio A, Valenti V, Tripoli A, Matranga D, Lo Casto A, Failla G, Di Miceli G, Ferrera G (2019) Prognostic value of two geriatric screening tools in a cohort of older patients with early stage non-small cell lung cancer treated with hypofractionated stereotactic radiotherapy. J Geriatr Oncol. https://doi.org/10.1016/j.jgo.2019.05.002
DeWees TA, Nikitas J, Rehman S, Bradley JD, Robinson CG, Roach MC (2018) Defining optimal comorbidity measures for patients with early stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Pract Radiat Oncol. https://doi.org/10.1016/j.prro.2018.09.001
Dewey M, Schink T, Dewey CF (2007) Claustrophobia during magnetic resonance imaging: Cohort study in over 55,000 patients. J Magn Reson Imaging 26(5):1322–1327
Donovan JL, Hamdy FC, Lane JA, Mason M, Metcalfe C, Walsh E et al (2016) Patient-reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 375(15):1425–1437. https://doi.org/10.1056/NEJMoa1606221
Droz JP, Albrand G, Gillessen S, Hughes S, Mottet N, Oudard S, Payne H, Puts M, Zulian G, Balducci L et al (2017) Management of prostate cancer in elderly patients: Recommendations of a task force of the international society of geriatric oncology. Eur Urol 72:521–531. https://doi.org/10.1016/j.eururo.2016.12.025
Fiorentino A, Ricchetti F, Mazzola R, Fersino S, Giaj Levra N, Alongi F, Regarding E et al (2015) Charlson comorbidity index: an additional prognostic parameter for preoperative glioblastoma patient stratification. J Cancer Res Clin Oncol. 141(6):1139–1140
Fiorentino A, Mazzola R, Giaj Levra N, Fersino S, Ricchetti F, Di Paola G et al (2018) Comorbidities and intensity-modulated radiotherapy with simultaneous integrated boost in elderly breast cancer patients. Aging Clin Exp Res 30(5):533–538
Fiorentino A, Gregucci F, Mazzola R, Figlia V, Ricchetti F, Sicignano G et al (2019) Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities. Radiol Med 124(4):309–314
Fiorentino A, Gregucci F, Mazzola R, Figlia V, Ricchetti F, Sicignano G, Giaj Levra N, Ruggieri R, Fersino S, Naccarato S, Massocco A, Corradini S, Alongi F (2019) Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elderly patients with breast cancer: comparison of acute and late toxicities. Radiol Med 124(4):309–314. https://doi.org/10.1007/s11547-018-0976-2
Fiorino C, Guckemberger M, Schwarz M, van der Heide UA, Heijmen B (2020) Technology-driven research for radiotherapy innovation. Mol Oncol. https://doi.org/10.1002/1878-0261.12659
Goineau A, Campion L, d'Aillières B, Vié B, Ghesquière A, Béra G, Jaffres D, de Laroche G, Magné N, Artignan X, Chamois J, Bergerot P, Martin E, Créhange G, Deniaud-Alexandre E, Buthaud X, Belkacémi Y, Doré M, de Decker L, Supiot S (2018) Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS ONE 13(4):e0194173. https://doi.org/10.1371/journal.pone.0194173
Hui R, Özgüroğlu M, Villegas A, Daniel D, Vicente D, Murakami S, Yokoi T, Chiappori A, Lee KH, de Wit M, Cho BC, Gray JE, Rydén A, Viviers L, Poole L, Zhang Y, Dennis PA, Antonia SJ (2019) Patient-reported outcomes with durvalumab after chemoradiotherapy in stage III, unresectable non-small-cell lung cancer (PACIFIC): a randomised, controlled, phase 3 study. Lancet Oncol 20(12):1670–1680. https://doi.org/10.1016/S1470-2045(19)30519-4
Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP et al (2011) Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol 29(25):3457–3465. https://doi.org/10.1200/JCO.2011.34.7625
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 341(27):2061–2067
Kenis C, Decoster L, Van Puyvelde K, De Grève J, Conings G, Milisen K et al (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32(1):19–26. https://doi.org/10.1200/JCO.2013.51.1345
Khor RC, Bressel M, Tedesco J, Tai KH, Ball DL, Duchesne GM, Farrugia H, Yip WK, Foroudi F (2015) Tolerability and outcomes of curative radiotherapy in patients aged 85 or more years. Med J Aust 202(3):153–155
Kopek N, Paludan M, Petersen J, Hansen AT, Grau C, Høyer M (2009) Co-morbidity index predicts for mortality after stereotactic body radiotherapy for medically inoperable early-stage non-small cell lung cancer. Radiother Oncol 93(3):402–407. https://doi.org/10.1016/j.radonc.2009.06.002
Kreinbrink P, Blumenfeld P, Tolekidis G, Sen N, Sher D, Marwaha G (2017) Lung stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer in the very elderly (≥ 80years old): extremely safe and effective. J Geriatr Oncol 8(5):351–355. https://doi.org/10.1016/j.jgo.2017.07.002
Lipsett A, Barrett S, Haruna F, Mustian K, O'Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast. 2017;32:144-155;
Liuu E, Canoui-Poitrine F, Tournigand C et al (2014) Accuracy of the G-8geriatric-oncology screening tool for identifying vulnerable elderly patients with cancer according to tumour site: the ELCAPA-02 study. J Geriatr Oncol 5:11–19. https://doi.org/10.1016/j.jgo.2013.08.003
Maebayashi T, Ishibashi N, Aizawa T, Sakaguchi M, Saito T, Kawamori J et al (2018) Significance of stereotactic body radiotherapy in older patients with early stage non-small cell lung cancer. J Geriatr Oncol 9(6):594–599. https://doi.org/10.1016/j.jgo.2018.03.005
Narayanan V, Koshy C (2009) Fatigue in cancer: a review of literature. Indian J Palliat Care 15(1):19–25
O'Donovan A, Leech M, Gillham C (2017) Assessment and management of radiotherapy induced toxicity in older patients. J Geriatr Oncol 8(6):421–427. https://doi.org/10.1016/j.jgo.2017.07.001
Padhani AR, Liu G, Koh DM, Chenevert TL, Thoeny HC, Takahara T et al (2009) Diffusion-weighted magnetic resonance imaging as a cancer biomarker: consensus and recommendations. Neoplasia 11(2):102–125
Postmus PE, Kerr KM, Oudkerk M, Senan S, Waller DA, Vansteenkiste J, et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28(suppl_4):iv1–iv21. https://doi.org/10.1093/annonc/mdx222
Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F et al (2015) G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer 9(15):875. https://doi.org/10.1186/s12885-015-1800-1
Radovic M, Kanesvaran R, Rittmeyer A, Früh M, Minervini F, Glatzer M et al (2018) Multidisciplinary treatment of lung cancer in older patients: a review. J Geriatr Oncol. https://doi.org/10.1016/j.jgo.2018.09.005
Ruggieri R, Naccarato S, Stavrev P, Stavreva N, Fersino S, Giaj Levra N, Mazzola R, Mancosu P, Scorsetti M, Alongi F (2015) Volumetric-modulated arc stereotactic body radiotherapy for prostate cancer: dosimetric impact of an increased near-maximum target dose and of a rectal spacer. Br J Radiol 88(1054):20140736
Triggiani L, Alongi F, Buglione M, Detti B, Santoni R, Bruni A, Maranzano E, Lohr F, D'Angelillo R, Magli A, Bonetta A, Mazzola R, Pasinetti N, Francolini G, Ingrosso G, Trippa F, Fersino S, Borghetti P, Ghirardelli P, Magrini SM (2017) Efficacy of stereotactic body radiotherapy in oligorecurrent and in oligoprogressive prostate cancer: new evidence from a multicentric study. Br J Cancer 116(12):1520–1525
Triggiani L, Mazzola R, Magrini SM, Ingrosso G, Borghetti P, Trippa F, Lancia A, Detti B, Francolini G, Matrone F, Bortolus R, Fanetti G, Maranzano E, Pasqualetti F, Paiar F, Bonù ML, Magli A, Bruni A, Mazzeo E, Franzese C, Scorsetti M, Alongi F, Jereczek-Fossa BA, Ost P, Buglione M (2019) Metastasis-directed stereotactic radiotherapy for oligoprogressive castration-resistant prostate cancer: a multicenter study. World J Urol 37(12):2631–2637
Videtic GMM, Woody NM, Reddy CA, Stephans KL (2017) Never too old: A single-institution experience of stereotactic body radiation therapy for patients 90 years and older with early stage lung cancer. Pract Radiat Oncol 7(6):e543–e549. https://doi.org/10.1016/j.prro.2017.06.011
Wang XS, Woodruff JF (2015) Cancer-related and treatment-related fatigue. Gynecol Oncol 136(3):446–452
Winkel D, Bol GH, Kroon PS, van Asselen B, Hackett SS, Werensteijn-Honingh AM et al (2019) Adaptive radiotherapy: the Elekta Unity MR-Linac concept. Clin Transl Radiat Oncol 18:54–59. https://doi.org/10.1016/j.ctro.2019.04.001
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Filippo Alongi is a consultant and speaker honoraria for Elekta; Ruggero Ruggieri is consultant for Elekta.
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Mazzola, R., Figlia, V., Rigo, M. et al. Feasibility and safety of 1.5 T MR-guided and daily adapted abdominal-pelvic SBRT for elderly cancer patients: geriatric assessment tools and preliminary patient-reported outcomes. J Cancer Res Clin Oncol 146, 2379–2397 (2020). https://doi.org/10.1007/s00432-020-03230-w