Table 2.
Overview of literature on alternative primary radiotherapy schedules and outcomes in elderly patients
| Study (year), type | Participants | Intervention and follow‐up | Reason for alternative treatment | Primary outcome |
|---|---|---|---|---|
| Cognetta et al.56 (2012), retrospective |
N = 1149 pts with 1715 non‐aggressive KCs. All pts >65 years |
Superficial X‐ray therapy (80 kV) with 35 Gy in 5 fractions, three times per week. 10‐year inclusion, average FU: 31.5 months (range: 1–120) | Patient preference | No effect of age on recurrence, multivariable HR: 0.99 (95% CI: 0.95–1.02) |
| Ferro et al.85 (2015), prospective phase II |
N = 31 pts with KC. All pts ≥70 years |
Electrons (6–9–12 MeV) or photons (6MV) with 30 Gy in 6 daily fractions. Median FU: 30 months (range: 8–72) | Unfit for other local treatments | Local control after 2 years 93.2% |
| Kouloulias et al.52 (2013), retrospective |
N = 38 pts with HNBCC. All pts ≥64 years |
Electrons (6 MeV) or photons (6MV) with 30 Gy in 5 weekly fractions. 7‐year inclusion, median FU: 48 months | Eligibility criteria based on location, tumour characteristics, immunosuppression and previous treatment | Three recurrences were found |
| Marriappan et al.53 (2014), retrospective cohort |
N = 25 pts with 37 BCCs. All pts ≥83 years |
42 Gy in 7 weekly fractions, no radiation technique mentioned. Median FU: 15 months (range: 1–89) | Unfit for daily treatment | Two recurrences were found |
| Pampena et al.38 (2016), retrospective cohort |
N = 385 pts with 436 KCs. Elderly disabled pts >60 years (I) vs. other pts (II) |
Orthovoltage, 37.75 Gy in 7 weekly fractions (I) or 45 Gy in 15 daily fractions (II). 6‐year inclusion, median FU: 31.8 months | Surgery was contraindicated or refused | No difference between treatment groups in OS (multivariable HR: 0.662, 95% CI: 0.387–1.131) DFS (multivariable HR: 0.483, 95% CI: 0.065–3.582), or cosmetic outcome (multivariable RR: 1.048, 95% CI: 0.170–6.473) |
| Pelissero et al.54 (2015), retrospective |
N = 117 pts with 141 facial BCCs. All pts frail and elderly, median age: 82 years (range: 75–103) |
Orthovoltage 55–150 kV or electrons 4–8 MeV with 25–30 Gy in 5–6 weekly fractions. 3‐year inclusion, median FU: 61 months (range: 42–85) | Unfit for daily radiation | Complete response in 98.3% of pts and 98.6% of tumours |
| Russi et al.55 (2015), retrospective |
N = 134 pts with 159 facial BCCs. All pts >75 years |
Orthovoltage 55‐150 kV or electrons 4–8 MeV with 25–30 Gy in 5–6 weekly fractions. Median FU: 64.5 months (range: 42–88) | Unfit for daily radiation | Complete response in 98.5% of pts and 98.7% of tumours. Recurrence in 3 pts |
| Terra et al.39 (2017), retrospective |
N = 48 pts with 52 HNcSCCs. Median age: 81 years (range: 50–100) |
Photons, electrons or orthovoltage (100–200 kV) with 55, 60 or 70 Gy in fractions of 2 Gy 5×/week. 14‐year inclusion, median FU: 23 months (95% CI: 20.9–29.9) | Not applicable, normal protocol | No effect of age on recurrence. Age > 50 univariable HR 0.486 (95% CI: 0.048–4.513), age >70 univariable HR: 0.864 (95% CI: 0.113–6.628) |
| Valeriani et al.86 (2017), prospective cohort |
N = 21 pts with 26 KCs. All pts >80 years |
Electrons (6–12 MeV) or photons (6MV) with 60 Gy in 10 or 12 weekly fractions. 4‐year inclusion, 2‐year FU | Unfit for surgery | Complete response in 92.4% of tumours. No effect of schedule on response or toxicity |
BCC, basal cell carcinoma; CI, confidence interval; DFS, disease‐free survival; FU, follow‐up; Gy, grey, HNBCC, head and neck basal cell carcinoma; HNcSCC, head and neck cutaneous squamous cell carcinoma; HR, hazard ratio; KC, keratinocyte carcinoma; kV, kilovolt; MeV, megaelectron volt; MV, megavolt; MMS, Mohs’ micrographic surgery; OR, odds ratio; OS, overall survival; pts, patients; RR, relative risk; RT, radiotherapy; vs, versus.