Radiation therapy in the elderly patient

In the management of cancer in the older patient, the treatment program designed should be based on careful analysis of the patient's problem and a decision made as to whether the patient can be cured by the radiation therapy technique for what is primarily a limited local regional disease process or palliated by virtue of the fact that the patient has more widespread disseminated disease. In both instances, careful attention must be given to proper, continuous and careful support of all the problems the older patient has. The patient's status may dictate a major change in the radiation therapy program by virtue of fractionation, protraction, total dose being delivered or even the volume being treated. The response to treatment in terms of normal tissue effects require careful medical management in order to minimize those effects. Interruptions of treatment should be allowed only if appropriate deliberate management of side effects are not effective. The basic principle in the management of the older patient with cancer is to allow for cure of those patients in which that is a reasonable possibility with the minimum in terms of complication as a consequence of the treatment program. Palliative radiation therapy programs are directed toward improvement in the quality of life by diminishing symptoms and hastening rehabilitation. When two definitive treatment programs, surgery or radiation therapy, have equal probability for long-term survival, the radiation therapy curatively administered would allow for the preservation of anatomy and function. The maximum potential for management in the older patient with cancer is achieved best in the circumstances of an integrated multimodal team for management including those specialists that are appropriate to the disease process being treated. These would include the surgeon, the radiation oncologist, the medical oncologist, the pathologist, the diagnostic radiologist, as well as other specialists such as anesthesiology, rehabilitation medicine, etc., along with paramedical support members of the team. It is within this environment that the maximum potentials of treatment can be achieved.