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@ARTICLE{Sprave:157089,
      author       = {T. Sprave$^*$ and A. Rühle$^*$ and R. Stoian$^*$ and A.
                      Weber$^*$ and C. Zamboglou$^*$ and C. Nieder and A.-L.
                      Grosu$^*$ and N. Nicolay$^*$},
      title        = {{R}adiotherapy for nonagenarians: the value of biological
                      versus chronological age.},
      journal      = {Radiation oncology},
      volume       = {15},
      number       = {1},
      issn         = {1748-717X},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2020-01380},
      pages        = {113},
      year         = {2020},
      abstract     = {The number of nonagenarian cancer patients (≥ 90 years)
                      is continuously increasing, and radiotherapy is performed in
                      a relevant proportion of patients, as surgery and
                      chemotherapy are often not feasible for these patients.
                      However, the evidence regarding the feasibility and
                      treatment outcomes after radiotherapy for this patient group
                      is very limited.All nonagenarian patients receiving (chemo)
                      radiotherapy between 2009 and 2019 at the University of
                      Freiburg - Medical Center were analyzed for patterns of
                      care, overall survival (OS) and therapy-associated
                      toxicities according to the Common Terminology Criteria for
                      Adverse Events. Uni- and multivariate Cox regression
                      analyses were conducted to assess the influence of patient-
                      and treatment-related factors on patient outcomes.One
                      hundred nineteen patients with a total of 137 irradiated
                      lesions were included in this analysis. After a median
                      follow-up of 27 months, median OS was 10 months with a
                      3-year OS amounting to $11.1\%.$ Univariate analyses
                      demonstrated that a reduced performance status
                      (HR = 1.56, $95\%$ CI 1.00-2.45, p < 0.05), a higher
                      burden of comorbidities (HR = 2.00, $95\%$ CI 1.00-4.10,
                      p < 0.05) and higher UICC tumor stages (HR = 2.21,
                      $95\%$ CI 1.14-4.26, p < 0.05) were associated with
                      impaired survival rates. Split-course treatments
                      (HR = 2.05, $95\%$ CI 1.07-3.94, p < 0.05),
                      non-completion of radiotherapy (HR = 7.17, $95\%$ CI
                      3.88-13.26, p < 0.001) and palliative treatments
                      (HR = 2.84, $95\%$ CI 1.68-4.81, p < 0.05) were
                      found to result in significantly reduced OS. In the
                      multivariate analysis, split-course concepts (HR = 2.21,
                      $95\%$ CI 1.10-4.37, p < 0.05) and palliative treatments
                      (HR = 3.19, $95\%$ CI 1.77-5.75, p < 0.001)
                      significantly deteriorated outcomes, while impaired ECOG
                      status (HR = 1.49, $95\%$ CI 0.91-2.43, p = 0.11) did
                      not. The vast majority of patients reported either no
                      (n = 40; $33.6\%)$ or grade 1-2 acute toxicities
                      (n = 66; $55.5\%),$ and only very few higher-grade
                      toxicities were observed in our study.Radiotherapy for
                      nonagenarian patients is generally feasible and associated
                      with a low toxicity profile. Given the relatively poor OS
                      rates and the importance of the quality of life for this
                      patient group, individualized treatment regimens including
                      hypofractionation concepts should be considered.},
      cin          = {FR01 / E055},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331 / I:(DE-He78)E055-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:32430009},
      pmc          = {pmc:PMC7236131},
      doi          = {10.1186/s13014-020-01563-x},
      url          = {https://inrepo02.dkfz.de/record/157089},
}