Possibilities of radiation therapy for skin cancer in long-lived patients (over 90 years old)

Abstract

Introduction. Skin cancer is one of the most common forms of malignant tumors in the Central Asian region and is frequently found in elderly and senile people. Often this pathology is also diagnosed in long-lived patients. Unfortunately, for long-lived patients the choice of adequate treatment methods presents particular difficulties due to the presence of concomitant diseases, a complex psycho-emotional state and expected complications. The inability to carry out specific antitumor treatment according to traditional programs leads to the progression of the tumor process and a significant decrease in the quality of life of patients.Aim. To determine the importance of radiation therapy in the treatment of skin cancer in long-lived patients (over 90 years old).Materials and methods. The study included 32 patients – 21 (65.62 %) men and 11 (34.38 %) women, all patients at the initial admission to a specialized medical institution were over the age of 90 years. Some patients were monitored and treated for several years in non-core institutions, they underwent various therapies for continued growth, relapses and metastases. Tumors affected various anatomical areas. Taking into account morphological and general clinical data, 5 (15.62 %) patients were diagnosed with skin cancer of stage T1N0M0, 6 (18.79 %) – T2N0M0, 14 (43.79 %) – T3N0–1M0–1, 7 (21.87 %) – T4N0–1M0–1, which indicates late treatment of patients to oncologists, despite the visual localization of skin cancer. Only 5 (15.62 %) of 32 patients underwent exclusively surgical intervention, telegammatherapy (TGT) as an independent type of treatment – 5 patients with disease in T1–2N0M0 stage. Patients with stage T3–4N0–1M0–1 disease received TGT in a single mode, probably due to the presence of contraindications or the inability to use other methods of treatment. Polychemotherapy in an independent variant was performed to 1 patient, combination therapy (TGT + surgery) – 9 (28.12 %), chemoradiotherapy – 3 (9.37 %), complex therapy (TGT + surgery + polychemotherapy).Results. Numerous scientific studies devoted to skin cancer, convincingly prove that this pathology mainly occurs in patients in the elderly and senile age (60–75 years). Our experience of treatment in 1049 patients with skin cancer confirms this fact. Standard approaches have been developed for the treatment of various forms of skin cancer, and clinicians achieve good results in the early stages of the disease. It is considered that the patient’s age is relative, and in some cases absolute, a contraindication for antitumor therapy. The assessment of the risk of skin cancer showed that it often occurs in long-lived patients (people over 90 years old) and accounts for 3.05 % of the total number of cases. During the treatment protocols of patients of this group, we were convinced of the reliably frequent localization of skin cancer in longlived patients in the head and neck (40.63 % of cases) and lower extremities (28.12 % of cases). It should be noted that in 4 out of 9 patients, the tumor developed against the background of various injuries and diseases. The majority of patients (21 (65.62 %) out of 32 patients), despite the visual localization of the tumor, turned to oncologists late when they had a locally advanced process or metastases (T3–4N0–1M0–1). The treatment in the form of combined and complex therapy was ineffective. At the same time, in the near term after treatment, signs of a residual tumor were detected in 6 (28.51 %) of 21 patients, relapses – in 4 (19.04 %), and metastasis to distant lymph nodes – in 3 (14.28 %). Probably, the aggressive course of skin cancer in long-lived patients is explained not only by the biological features of the disease, but also by the physiological characteristics of the body. Contrary to existing opinions, the majority of long-lived patients can undergo combined and complex therapy, including repeated courses of radiation therapy with their adequate use.Conclusion. Despite the advanced age, the presence of concomitant diseases, limited physical abilities, long-lived patients need adequate methods of specialized treatment. Age over 90 years is not an absolute contraindication for antitumor therapy, on the contrary, its adequate choice significantly improves the quality of life of patients. When relapses and metastases of skin cancer appear in long-lived patients, combined and complex antitumor therapy can be performed after a thorough assessment of their condition.