Using Proton Beam Therapy in the Elderly Population

A Snapshot of Current Perception and Practice

Juliette Thariat, Terence Sio, Pierre Blanchard, Samir Patel, Yusuke Demizu, Federico Ampil, Sebastien Guihard, Robert C. Miller, Ulf Karlsson, Marco Krengli, Huan Giap, Nam Nguyen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: With limited proton therapy (PT) resources, several centers have designed their own decision-making systems for PT slot prioritization. The pediatric population is well recognized for deriving benefits from PT; however, elderly patients are not a focus for PT. When should PT be considered for use in the elderly population? Methods and Materials: We performed a pilot survey of 25 international academic radiation oncologists (ROs) who also spend significant amounts of clinical time caring for elderly patients. Results: Of the 12 respondents (48%), 58% used photons only, 17% used protons only, and 25% used photons and protons. Their definition of elderly was age ≥70 years. Geriatric evaluation was not systematic. Hypofractionation (60%) and decrease in total dose (50%) were advocated by half the ROs on the basis of age. Target volumes were similar to those in young patients for 80% of ROs. Organs at risk (OARs) associated with vulnerability and constraints to these OARs were considered different for 40% and 10% of ROs, respectively. Priorities for PT were ranked from highest to lowest as follows: survival, toxicity, quality of life, tumor coverage, locoregional control, patient's wish, dose to vulnerable OARs (oral mucosa, esophagus), quality-adjusted life-years, cost, irradiated volume, and integral dose. All ROs considered elderly patients eligible for accrual in clinical trials. Conclusions: This snapshot survey showed the current gap between chronological age and eventual PT allocation among some PT centers worldwide. The findings suggest that elderly age may become an even weaker argument against PT in the future. They also point out a lack of a systematic geriatric approach. As PT might be regarded as a relevant therapeutic means in the elderly population to limit the toxicity burden and hospital costs, better guidance to allocate PT for this growing segment of the population is still needed.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Nov 5 2016

Fingerprint

Proton Therapy
proton beams
therapy
protons
Population
Organs at Risk
geriatrics
organs
radiation
Photons
Geriatrics
Protons
toxicity
dosage
Quality-Adjusted Life Years
Hospital Costs
costs
esophagus
Mouth Mucosa
vulnerability

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Using Proton Beam Therapy in the Elderly Population : A Snapshot of Current Perception and Practice. / Thariat, Juliette; Sio, Terence; Blanchard, Pierre; Patel, Samir; Demizu, Yusuke; Ampil, Federico; Guihard, Sebastien; Miller, Robert C.; Karlsson, Ulf; Krengli, Marco; Giap, Huan; Nguyen, Nam.

In: International Journal of Radiation Oncology Biology Physics, 05.11.2016.

Research output: Contribution to journalArticle

Thariat, J, Sio, T, Blanchard, P, Patel, S, Demizu, Y, Ampil, F, Guihard, S, Miller, RC, Karlsson, U, Krengli, M, Giap, H & Nguyen, N 2016, 'Using Proton Beam Therapy in the Elderly Population: A Snapshot of Current Perception and Practice', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2017.01.007
Thariat, Juliette ; Sio, Terence ; Blanchard, Pierre ; Patel, Samir ; Demizu, Yusuke ; Ampil, Federico ; Guihard, Sebastien ; Miller, Robert C. ; Karlsson, Ulf ; Krengli, Marco ; Giap, Huan ; Nguyen, Nam. / Using Proton Beam Therapy in the Elderly Population : A Snapshot of Current Perception and Practice. In: International Journal of Radiation Oncology Biology Physics. 2016.
@article{917682d80f7d4c858290fde2542ca703,
title = "Using Proton Beam Therapy in the Elderly Population: A Snapshot of Current Perception and Practice",
abstract = "Purpose: With limited proton therapy (PT) resources, several centers have designed their own decision-making systems for PT slot prioritization. The pediatric population is well recognized for deriving benefits from PT; however, elderly patients are not a focus for PT. When should PT be considered for use in the elderly population? Methods and Materials: We performed a pilot survey of 25 international academic radiation oncologists (ROs) who also spend significant amounts of clinical time caring for elderly patients. Results: Of the 12 respondents (48{\%}), 58{\%} used photons only, 17{\%} used protons only, and 25{\%} used photons and protons. Their definition of elderly was age ≥70 years. Geriatric evaluation was not systematic. Hypofractionation (60{\%}) and decrease in total dose (50{\%}) were advocated by half the ROs on the basis of age. Target volumes were similar to those in young patients for 80{\%} of ROs. Organs at risk (OARs) associated with vulnerability and constraints to these OARs were considered different for 40{\%} and 10{\%} of ROs, respectively. Priorities for PT were ranked from highest to lowest as follows: survival, toxicity, quality of life, tumor coverage, locoregional control, patient's wish, dose to vulnerable OARs (oral mucosa, esophagus), quality-adjusted life-years, cost, irradiated volume, and integral dose. All ROs considered elderly patients eligible for accrual in clinical trials. Conclusions: This snapshot survey showed the current gap between chronological age and eventual PT allocation among some PT centers worldwide. The findings suggest that elderly age may become an even weaker argument against PT in the future. They also point out a lack of a systematic geriatric approach. As PT might be regarded as a relevant therapeutic means in the elderly population to limit the toxicity burden and hospital costs, better guidance to allocate PT for this growing segment of the population is still needed.",
author = "Juliette Thariat and Terence Sio and Pierre Blanchard and Samir Patel and Yusuke Demizu and Federico Ampil and Sebastien Guihard and Miller, {Robert C.} and Ulf Karlsson and Marco Krengli and Huan Giap and Nam Nguyen",
year = "2016",
month = "11",
day = "5",
doi = "10.1016/j.ijrobp.2017.01.007",
language = "English (US)",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Using Proton Beam Therapy in the Elderly Population

T2 - A Snapshot of Current Perception and Practice

AU - Thariat, Juliette

AU - Sio, Terence

AU - Blanchard, Pierre

AU - Patel, Samir

AU - Demizu, Yusuke

AU - Ampil, Federico

AU - Guihard, Sebastien

AU - Miller, Robert C.

AU - Karlsson, Ulf

AU - Krengli, Marco

AU - Giap, Huan

AU - Nguyen, Nam

PY - 2016/11/5

Y1 - 2016/11/5

N2 - Purpose: With limited proton therapy (PT) resources, several centers have designed their own decision-making systems for PT slot prioritization. The pediatric population is well recognized for deriving benefits from PT; however, elderly patients are not a focus for PT. When should PT be considered for use in the elderly population? Methods and Materials: We performed a pilot survey of 25 international academic radiation oncologists (ROs) who also spend significant amounts of clinical time caring for elderly patients. Results: Of the 12 respondents (48%), 58% used photons only, 17% used protons only, and 25% used photons and protons. Their definition of elderly was age ≥70 years. Geriatric evaluation was not systematic. Hypofractionation (60%) and decrease in total dose (50%) were advocated by half the ROs on the basis of age. Target volumes were similar to those in young patients for 80% of ROs. Organs at risk (OARs) associated with vulnerability and constraints to these OARs were considered different for 40% and 10% of ROs, respectively. Priorities for PT were ranked from highest to lowest as follows: survival, toxicity, quality of life, tumor coverage, locoregional control, patient's wish, dose to vulnerable OARs (oral mucosa, esophagus), quality-adjusted life-years, cost, irradiated volume, and integral dose. All ROs considered elderly patients eligible for accrual in clinical trials. Conclusions: This snapshot survey showed the current gap between chronological age and eventual PT allocation among some PT centers worldwide. The findings suggest that elderly age may become an even weaker argument against PT in the future. They also point out a lack of a systematic geriatric approach. As PT might be regarded as a relevant therapeutic means in the elderly population to limit the toxicity burden and hospital costs, better guidance to allocate PT for this growing segment of the population is still needed.

AB - Purpose: With limited proton therapy (PT) resources, several centers have designed their own decision-making systems for PT slot prioritization. The pediatric population is well recognized for deriving benefits from PT; however, elderly patients are not a focus for PT. When should PT be considered for use in the elderly population? Methods and Materials: We performed a pilot survey of 25 international academic radiation oncologists (ROs) who also spend significant amounts of clinical time caring for elderly patients. Results: Of the 12 respondents (48%), 58% used photons only, 17% used protons only, and 25% used photons and protons. Their definition of elderly was age ≥70 years. Geriatric evaluation was not systematic. Hypofractionation (60%) and decrease in total dose (50%) were advocated by half the ROs on the basis of age. Target volumes were similar to those in young patients for 80% of ROs. Organs at risk (OARs) associated with vulnerability and constraints to these OARs were considered different for 40% and 10% of ROs, respectively. Priorities for PT were ranked from highest to lowest as follows: survival, toxicity, quality of life, tumor coverage, locoregional control, patient's wish, dose to vulnerable OARs (oral mucosa, esophagus), quality-adjusted life-years, cost, irradiated volume, and integral dose. All ROs considered elderly patients eligible for accrual in clinical trials. Conclusions: This snapshot survey showed the current gap between chronological age and eventual PT allocation among some PT centers worldwide. The findings suggest that elderly age may become an even weaker argument against PT in the future. They also point out a lack of a systematic geriatric approach. As PT might be regarded as a relevant therapeutic means in the elderly population to limit the toxicity burden and hospital costs, better guidance to allocate PT for this growing segment of the population is still needed.

UR - http://www.scopus.com/inward/record.url?scp=85014002384&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014002384&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2017.01.007

DO - 10.1016/j.ijrobp.2017.01.007

M3 - Article

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

ER -