Radiation therapy of the older patient.

Cancer in the geriatric population is a significant public health issue in the United States today. Currently, 60% of all malignant tumors occur in individuals aged 65 years and older. Nearly 70% of all cancer deaths occur in this age group. Currently about 12% of the population is over 65 years old, and this figure will rise to 20% in the year 2030. As age advances, the incidence of cancer increases dramatically 148 in both men and women (Fig. 1). The effect of aging is more apparent in certain cancers. Thirty-five percent of all colon cancers occur in women aged 80 or older; the median age at diagnosis is 75 years. By age 90, 90% of men will have prostate cancer. The distribution of cancer incidence in persons aged 65 years and older is given in Table 1. Currently, older patients with cancer are evaluated and treated less aggressively than their younger counterparts. 55 Older patients are less likely to receive combined-modality therapy. 118 There are few clinical trials for patients over the age of seventy-five years. Older patients are excluded from the existing trials because of concerns regarding the toxicity and lack of benefit from treatment. 67,195 As an alternative to surgery and to systemic chemotherapy, 23 radiotherapy is of particular benefit to older and frail cancer patients. It is widely used with curative and palliative intent. The information concerning the effectiveness and tolerance of radiation in the older patients is limited, however. Few books or publications have dealt with this aspect of oncology. Many older patients are either not treated or are undertreated because of the fear of treatment-related toxicities. 40,55,70,116,156 Approximately two thirds of younger patients are managed by multimodality therapy, as compared with only one third of patients more than 75 years old. 41 This article reviews the current information regarding the effectiveness and toxicity of radiotherapy in older individuals and presents the available data specific to major cancer sites.