Authors : R. Laraichi; S. Smiti; F.Z. Chraa; C. Ezzouitina; T. Edith; I. Lahdiri; K. Nouni; A. Lachgar; H. El Kacemi; T. Kebdani; K. Hassouni

Volume/Issue : Volume 10 - 2025, Issue 3 - March

Google Scholar : https://tinyurl.com/35k7uxw5

Scribd : https://tinyurl.com/3fhbhfkz

DOI : https://doi.org/10.38124/ijisrt/25mar293

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Purpose: To assess the percentage of elderly patients not receiving brachytherapy in our practice and identify the factors influencing the decision to forgo this therapeutic modality in this population.  Materiel and Methods: A retrospective study including patients aged ≥ 65 years old admitted in the brachytherapy unit, at the radiotherapy department of the national institute of oncology Sidi Mohamed ben Abdellah in Rabat, for a year. The characteristics of the included patients were examined as well as the modality of administration of brachytherapy. For cases where intracavitary ICBT could not be feasible, reasons behind its non-practice were determined.  Results: Patients ≥ 65 years old represented 31% (n=38) of all patients admitted in one year in the brachytherapy unit (average age was 71,8 years). Comorbidities were present in 20 patients (53%). All patients received treatment using external beam radiation therapy (EBRT), 81,6% with concurrent chemotherapy. HDR brachytherapy was performed in 65,8 % of our patients, delivered in three or four sessions. Causes of impractical intracavitary brachytherapy in elderly patients with cervical cancer revealed that the size of the residual tumor was the most common factor Identified.  Conclusion: Age is not a limiting factor for receiving suitable brachytherapy treatment, moreover elderly cervical cancer patients should receive brachytherapy if their performance status is adequate and the extent and severity of comorbidities do not contraindicate it. The most commonly cited reasons for not performing brachytherapy was tumor-related factors, Hence the importance of early diagnosis and screening in this age group

References :

1. WHO. Ageing and health 2018. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
2. MORICEAU Michel, WEBER Catherine, « Cancer chez la personne âgée : démarche oncogériatrique et dépistage des patients fragiles pour une prise en charge optimale », InfoKara, 2007/2 (Vol. 22), p. 49-55. DOI : 10.3917/inka.072.0049. URL : https://www.cairn.info/revue-infokara1-2007-2-page-49.htm
3. Valentina Lancellotta, György Kovács, Luca Tagliaferri, Elisabetta Perrucci, Giuseppe Colloca, Vincenzo Valentini, Cynthia Aristei. Age Is Not a Limiting Factor in Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer First published: 21 January 2018 https://doi.org/10.1155/2018/2178469.
4. L. P. Fried and W. J. Hall, “Editorial: Leading on behalf of an aging society,” Journal of the American Geriatrics Society, vol. 56,no.10,pp.1791–1795,2008.
5. J. S. Goodwin, J. M. Samet, and W. C. Hunt, “Determinants of Survival in Older Cancer Patients, ”JNCI Journal of the National Cancer Institute,vol.88,no.15,pp.1031–1038,1996.
6. S.Cykert,P.Dilworth-Anderson,M.H.Monroeetal.,“Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer,” Journal of the American Medical Association, vol.303, no.23, pp.2368–2376, 2010.
7. Kennedy AW, Julie SF, Webster KD, Gynecologic cancer in the very elderly. Gynecol Oncol 1989,32:49-54.
8. Mitchell PA, Waggoner S, Rotmensch J, Mundt AJ. Cervical cancer in the elderly treated with radiation therapy. Gynecol Oncol 1998; 71: 291–298.
9. Toita T, Kitagawa R, Hamano T et al. Phase II study of concurrent chemoradiotherapy with high-dose-rate intracavitary brachytherapy in patients with locally advanced uterine cervical cancer: Efficacy and toxicity of a low cumulative radiation dose schedule. Gynecol Oncol 2012; 126: 211–216. 12.
10. Stewart AJ, Viswanathan AN. Current controversies in highdose-rate versus low-dose-rate brachytherapy for cervical cancer. Cancer 2006; 107: 908–915.
11. Yumi Yanazume, Shintaro Yanazume, Kazuto Iio, Ryuji Yonekura. Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer . J. Obstet. Gynaecol. Res. Vol. 40, No. 6: 1725–1732, June 2014. doi:10.1111/jog.12387
12. D/.Benrath J., Kozek-Langenecker S., Hupfl M., Lierz P., Gustorff B. Anaesthesia for brachytherapy–51/2 yr of experience in 1622 procedures. Br J Anaesth. 2006;96(2):195–200. doi: 10.1093/bja/aei301. [DOI] [PubMed] [Google Scholar]
13. Magne N, Mancy NC, Chajon E et al. Patterns of care and outcome in elderly cervical cancer patients :A special focus on brachytherapy. Radiother Oncol 2009; 91: 197–201.
14. Farage M, Maibach H. Lifetime changes in the vulva and vagina. Arch Gynecol Obstet 2006; 273: 195–202.
15. Ma T.M., Harkenrider M.M., Yashar C.M., Viswanathan A.N., Mayadev J.S. Understanding the underutilization of cervical brachytherapy for locally advanced cervical cancer. Brachytherapy. 2019;18(3):361–369. doi: 10.1016/j.brachy.2018.12.002. [DOI] [PubMed] [Google Scholar]
16. Mayadev J., Klapheke A., Yashar C., Hsu I.C., Kamrava M., Mundt A.J. Underutilization of brachytherapy and disparities in survival for patients with cervical cancer in California. Gynecol Oncol. 2018;150(1):73–78. doi: 10.1016/j.ygyno.2018.04.563. [DOI] [PubMed] [Google Scholar]
17. Moore K.N., Java J.J., Slaughter K.N., Rose P.G., Lanciano R., DiSilvestro P.A. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/ Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol. 2016;143(2):294–301. doi: 10.1016/j.ygyno.2016.08.317. [DOI] [PMC free article] [PubMed] [Google Scholar]
18. Kobayashi D., Okonogi N., Wakatsuki M., Miyasaka Y., Kiyohara H., Ohno T. Impact of CT-based brachytherapy in elderly patients with cervical cancer. Brachytherapy. 2019;18(6):771–779. doi: 10.1016/j.brachy.2019.08.002. [DOI] [PubMed] [Google Scholar]
19. Han K., Viswanathan A.N. Brachytherapy in gynecologic cancers: why is it underused? Curr Oncol Rep. 2016;18(4):26. doi: 10.1007/s11912-016-0508-y. [DOI] [PubMed] [Google Scholar]
20. Thiruthaneeswaran N, Tharmalingam H, Hoskin PJ. Practical brachytherapy solutions to an age-old quandary. Tech Innov Patient Support Radiat Oncol. 2020 Oct 26;16:39-47. doi: 10.1016/j.tipsro.2020.09.004. PMID: 33385072; PMCID: PM C7769855.