Geriatric determinants of curative radiotherapy scheme choice for older adults with breast cancer treatment compliance and tolerance: Results from the GERABEL study

Introduction

Chronological and functional aging complicates care in older patients, and therapeutic decisions need to consider individual needs to minimise morbidity and mortality. Therapeutic decisions should be guided by a multidisciplinary geriatric assessment, allowing a complete assessment of physical and functional performance. In this context, the GERABEL study aimed to orientate the irradiation strategy based on a detailed oncogeriatric assessment in women more than 70 years old with breast cancer.

Materials and Methods

This was a multicentre clinical trial conducted between January 2017 and June 2021. The oncogeriatric assessment comprised seven questionnaires (activities of daily living [ADL], instrumental ADL, Mini-Mental State Examination, mini Geriatric Depression Scale, Mini-Nutritional Assessment, Cumulative Illness Rating Scale-Geriatric, and Timed Up and Go) to determine a predictive score. Irradiation regimen was assigned according to oncogeriatric score: normofractionated – NF (score range, 160–200), hypofractionated – HF (score range, 159–120), or high-dose hypofractionated – HDHF (score ≤ 119). Endpoints were the overall tolerance to treatment, using the oncogeriatric score as a proxy at six months post-treatment, and compliance.

Results

After oncogeriatric assessment at baseline, 177 patients were treated with a NF regimen, 24 with a HF regimen, and four with a HDHF regimen. Tolerance was excellent in the three groups, as no decrease of more than 20 % in the oncogeriatric score was noted at six months post-treatment. More generally, 68 % and 73 % of patients reported an improvement of the oncogeriatric score at two months and six months post-treatment, respectively. Only four treatment interruptions were observed and quality-of-life was well-conserved. In the hypo fractionated groups, short-term toxicities were not increased and no impact was noted on compliance.

Discussion

Decision-making guidance for irradiation schemes in breast cancer according to oncogeriatric determinants was successful in older patients, who tolerated treatment well and, overall, had a preserved general condition.