Is Advanced Age a Limiting Factor in the Practice of High Dose Rate Brachytherapy in Patients Treated for Cervical Cancer?

Purpose: To assess the percentage of elderly patients not receiving brachytherapy in our practice and identify the factors influencing the decision to forgo this therapeutic modality in this population.  Materiel and Methods: A retrospective study including patients aged ≥ 65 years old admitted in the brachytherapy unit, at the radiotherapy department of the national institute of oncology Sidi Mohamed ben Abdellah in Rabat, for a year. The characteristics of the included patients were examined as well as the modality of administration of brachytherapy. For cases where intracavitary ICBT could not be feasible, reasons behind its non-practice were determined.  Results: Patients ≥ 65 years old represented 31% (n=38) of all patients admitted in one year in the brachytherapy unit (average age was 71,8 years). Comorbidities were present in 20 patients (53%). All patients received treatment using external beam radiation therapy (EBRT), 81,6% with concurrent chemotherapy. HDR brachytherapy was performed in 65,8 % of our patients, delivered in three or four sessions. Causes of impractical intracavitary brachytherapy in elderly patients with cervical cancer revealed that the size of the residual tumor was the most common factor Identified.  Conclusion: Age is not a limiting factor for receiving suitable brachytherapy treatment, moreover elderly cervical cancer patients should receive brachytherapy if their performance status is adequate and the extent and severity of comorbidities do not contraindicate it. The most commonly cited reasons for not performing brachytherapy was tumor-related factors, Hence the importance of early diagnosis and screening in this age group