Estimating Radiation Therapy Toxicity and Tolerability with Comprehensive Assessment Parameters in Geriatric Cancer Patients

  • Ulger, Sukran (Gazi University School of Medicine, Department of Radiation Oncology, Division of Geriatrics) ;
  • Kizilarslanoglu, Muhammet Cemal (Gazi University School of Medicine, Department of Internal Medicine, Division of Geriatrics) ;
  • Kilic, Mustafa Kemal (Gazi University School of Medicine, Department of Internal Medicine, Division of Geriatrics) ;
  • Kilic, Diclehan (Gazi University School of Medicine, Department of Radiation Oncology, Division of Geriatrics) ;
  • Cetin, Bekir Eren (Gazi University School of Medicine, Department of Radiation Oncology, Division of Geriatrics) ;
  • Ulger, Zekeriya (Gazi University School of Medicine, Department of Internal Medicine, Division of Geriatrics) ;
  • Karahacioglu, Eray (Gazi University School of Medicine, Department of Radiation Oncology, Division of Geriatrics)
  • Published : 2015.03.18


Cancer prevalance and incidence is increasing with aging of populations and age is a critical factor in decision-making for anti-cancer treatment. However it is believed that chronological age is not enough to guide management in elderly cancer patients. Multidisciplinary evaluation and comprehensive geriatric assessment has gained importance regarding the treatment selection especially for definitive anti-cancer therapy recently. We here aimed to analyse the effect of the comprehensive geriatric assessment parameters on radiotherapy toxicity and tolerability in a series of geriatric cancer patients in Turkey.


Comprehensive assessment;elderly;cancer;radiotherapy;geriatric oncology


  1. Aliamus V, Adam C, Druet-Cabanac M, Dantoine T, Vergnenegre A (2011). Geriatric assessment contribution to treatment decision-making in thoracic oncology. Revue Des Maladies Respiratoires, 28, 1124-30.
  2. Arnson Y, Amital H, Shoenfeld Y (2007). Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis, 66, 1137-42.
  3. Borison HL, Wang SC (1953). Physiology and pharmacology of vomiting. Pharmacol Rev, 5, 193-230.
  4. Brugel L, Laurent M, Caillet P, et al (2014). Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer, 14, 427.
  5. Bruyere O, Cavalier E, Souberbielle JC, et al (2014). Effects of vitamin D in the elderly population: current status and perspectives. Arch Public Health, 28, 32.
  6. Cox JD, Stetz J, Pajak TF (1995). Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Intern J Radiat Oncol Biol Phys, 31, 1341-6.
  7. Durdux C, Bauer C (2008). Radiation therapy in elderly patients. Cancer Radiotherapie, 12, 548-53.
  8. Durdux C, Boisserie T, Gisselbrecht M (2009). Radiation therapy in elderly patients. Cancer Radiotherapie, 13, 609-14.
  9. Extermann M, Aapro M, Bernabei R, et al (2005). Task force on CGA of the international society of geriatric oncology. use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the international society of geriatric oncology (SIOG). Critical Rev Oncol Hematol, 55, 241-52.
  10. Extermann M, Hurria A (2007). Comprehensive geriatric assessment for older patients with cancer. J Clinical Oncol, 25, 1824-31.
  11. Folstein MF, Folstein SE, McHugh PR (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res, 12, 189-98.
  12. Freyer G, Geay JF, Touzet S, et al (2005). Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol, 16, 1795-800.
  13. Gomez-Millan J (2009). Radiation therapy in the elderly: more side effects and complications? Critical Rev Oncol Hematol, 71, 70-8.
  14. Hamaker ME, Prins MC, Stauder R (2014). The relevance of a geriatric assessment for elderly patients with a haematological malignancy-a systematic review. Leukemia Res, 38, 275-83.
  15. Inamoto T, Azuma H, Nonomura N, et al (2014). Favorable outcome in elderly Asian patients with metastatic renal cell carcinoma treated with everolimus: the Osaka urologic oncology group. Asian Pac J Cancer Prev, 15, 1811-5.
  16. Kanesvaran R, Li H, Koo KN, Poon D (2011). Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol, 29, 3620-7.
  17. Lawton MP, Brody EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-86.
  18. Le Fur E, Chatellier G, Berger A, et al (2013). Tolerance and efficacy of preoperative radiation therapy for elderly patients treated for rectal cancer. Cancer Radiotherapie, 17, 202-7.
  19. Li M, Chen P, Li J, et al (2014). Review: the impacts of circulating 25-hydroxyvitamin D levels on cancer patient outcomes: a systematic review and meta-analysis. J Clin Endocrinol Metabol, 99, 2327-36.
  20. Ma Y, Zhang P, Wang F, et al (2011). Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Bone Miner Res, 29, 3775-82.
  21. Mahoney FI, Barthel DW (1965). Functional evaluation: the barthel index. Maryland State Med J, 14, 61-5.
  22. Mathias S, Nayak US, Isaacs B (1986). Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabilitat, 67, 387-9.
  23. Naylor RJ, Inall FC (1994). The physiology and pharmacology of postoperative nausea and vomiting. Anaesthesia, 49, 2-5.
  24. Oran ES, Yankol Y, Soybir GR, et al (2014). Distinct postsurgical management in young and elderly breast cancer patients results in equal survival rates. Asian Pac J Cancer Prev, 15, 7843-7.
  25. Pal SK, Hurria A (2010). Impact of age, sex, and comorbidity on cancer therapy and disease progression. J Clin Oncol, 28, 4086-93.
  26. Puts MT, Santos B, Hardt J, et al (2014 ). An update on a systematic review of the use of geriatric assessment for older adults in oncology. Ann Oncol, 25, 307-15.
  27. Rao AV, Hsieh F, Feussner JR, Cohen HJ (2005). Geriatric evaluation and management units in the care of the frail elderly cancer patient. J Gerontol Series A, Biological Sci Med Sci, 60, 798-803.
  28. Ramjaun A, Nassif MO, Krotneva S, Huang AR, Meguerditchian AN (2013). Improved targeting of cancer care for older patients: a systematic review of the utility of comprehensive geriatric assessment. J Geriatric Oncol, 4, 271-81.
  29. Rodrigues G, Sanatani M (2012). Age and comorbidity considerations related to radiotherapy and chemotherapy administration. Seminars Radiat Oncol, 22, 277-83.
  30. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B (2001). Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol Series A, Biological Sci Med Sci, 56, 366-72.
  31. Shua-Haim J, Koppuzha G, Gross J (1996). A simple scoring system for clock drawing in patients with Alzheimer's disease. J Am Geriatrics Soc, 44, 335.
  32. Spyropoulou D, Pallis AG, Leotsinidis M, Kardamakis D (2014). Completion of radiotherapy is associated with the Vulnerable Elders Survey-13 score in elderly patients with cancer. J Geriatric Oncol, 5, 20-5.
  33. Varol U, Dirican A, Yildiz I, et al (2014). First-line monochemotherapy in frail elderly patients with metastatic colorectal cancer. Asian Pac J Cancer Prev, 15, 3157-61.
  34. Yancik R, Yates JW, Cumberlin R (1999). Research recommendations for radiation therapy in older cancer patients. report from the national institute on aging, National cancer institute, and American college of radiology Workshop: radiation therapy and cancer in older persons. Intern J Radiat Oncol, Biol, Phys, 43, 3-5.
  35. Yesavage JA, Brink TL, Rose TL, et al (1982). Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatric Res, 17, 37-49.

Cited by

  1. Radical Oncological Surgery and Adjuvan Therapy in Non-Small Cell Lung Cancer Patients over 70 years of Age vol.16, pp.11, 2015,
  2. Managing an Older Adult with Cancer: Considerations for Radiation Oncologists vol.2017, pp.2314-6141, 2017,
  3. National Survey Among Radiation Oncology Residents Related to Their Needs in Geriatric Oncology pp.1543-0154, 2017,