Adjuvant Treatment and Clinical Trials in Elderly Patients With Endometrial Cancer A Time for Change?
Adjuvant Treatment and Clinical Trials in Elderly Patients With Endometrial Cancer A Time for Change?
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DOI：
10.1097/igc.0000000000000605
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发表时间：
2016-02-01
影响因子：
4.8
通讯作者：
Ko, Emily M.
中科院分区：
文献类型：
--
作者：
Clark, Leslie H.;Jackson, Amanda L.;Ko, Emily M.
目的：本研究的目的是评估老年子宫内膜癌（EC）患者推荐和接受辅助治疗之间的差距，并确定符合代表性妇科肿瘤组（GOG）试验入选标准的70岁及以上女性的百分比。方法和材料：对2005年至2010年来自三级医疗机构的所有EC病例进行了机构审查委员会批准的回顾性图表审查。临床、手术和病理数据从电子病历中提取。选择妇科肿瘤组方案249、209和229 L作为代表性国家EC试验。每个协议的criteria.Results：百分之二十六（280/1064）的EC患者的年龄超过70岁的资格进行了评估。超过60%（181/280）的老年EC患者被推荐接受辅助治疗。根据治疗类型，64%（48/75）的推荐辅助放疗的老年患者接受了辅助放疗，53%（49/92）的推荐联合化疗和放疗的老年患者接受了辅助放疗，29%（4/14）的推荐化疗的老年患者接受了辅助放疗。30%（40/134）符合病理学条件的患者将因医疗许可而被排除;对于GOG 209，31%（26/86）将被排除;对于GOG 229 L，9%（4/45）将纯粹因医疗原因而被排除。由于老年患者晚期疾病和侵袭性组织病理学的发生率较高，因此建议更多的辅助治疗。此外，由于约三分之一的70岁以上符合病理学入选标准的老年女性因复杂的内科疾病而被排除，因此老年患者的临床试验数据有限。
Objectives: The aim of the study were to evaluate the gap between recommended and received adjuvant therapy in elderly patients with endometrial cancer (EC) and to determine the percent of women 70 years and older who would meet enrollment criteria for representative Gynecologic Oncology Group (GOG) trials.Methods and Materials: An institutional review board approved retrospective chart review of all EC cases from a tertiary care institution from 2005 to 2010 was performed. Clinical, surgical, and pathologic data were abstracted from electronic medical records. Gynecologic Oncology Group protocols 249, 209, and 229L were selected as representative national EC trials. Patients were evaluated for eligibility by each protocol's criteria.Results: Twenty-six percent (280/1064) of patients with EC were older than 70 years. More than 60% (181/280) of elderly patients with EC were recommended to undergo adjuvant therapy. By therapy type, 64% (48/75) of elderly patients who were recommended adjuvant radiation received it, 53% (49/92) of elderly patients who were recommended combination chemotherapy and radiation received it, and 29% (4/14) of elderly patients who were recommended chemotherapy received it. In evaluating enrollment criteria for GOG 249, 30% (40/134) of pathologically eligible patients would have been eliminated for medical clearance; for GOG 209, 31% (26/86) would have been eliminated, and for GOG 229L, 9% (4/45) would have been eliminated purely for medical reasons.Conclusions: More adjuvant treatment is recommended in the elderly patients because of a higher incidence of advanced disease and aggressive histopathology. Approximately half of the elderly patients who were recommended treatment actually received it. In addition, clinical trial data are limited for elderly patients because approximately one third of the women aged 70 years and older who meet pathologic enrollment criteria for trials were excluded because of complex medical disease.