[Chemotherapy in the elderly]

Because of the increase in the incidence of malignancies with advancing age, we have need to make decision on the chemotherapy of elderly patients with cancer. However, until recently, studies about response to treatment and toxicities in the elderly patients have been quite limited. Many of clinical trials have excluded elderly patients with advanced cancer. In leukemia and Hodgkin's lymphoma, definite trends of decreased levels of response and survival in relationship to increased age have been reported. This reduced rates of response in elderly leukemia patients do not appear to be due to chemotherapy resistance but rather to high rates of death among elderly patients during remission induction therapy or to inadequate salvage therapy. On the other hand, older patients with solid cancers can be treated with chemotherapy as successfully as younger patients. General expectations of response, remission, and survival are similar for the older and younger patients. With the exception of small increase in the incidence of hematologic toxicity in the older group, both younger and older patients experience the same frequency of toxic reactions. Aging is a highly individualized process that cannot be defined by chronological landmarks. Therefore, it can be said that there is no reason to exclude from adequate chemotherapy, simply on the basis of age alone. But, observations on the proper role of chemotherapy in older patients are very limited, and further studies are needed in this area.