ESTRO 2024 - Abstract Book

S61 ESTRO 2024 resolution post-biopsy in 4 patients; no complete resolution seen. 3-year FFP for RT alone was 100 % vs 61 % for surgery alone (p = 0.12). Conclusion: RT is a successful, non-invasive option for PCSMLPD: 100 % achieved complete response, with no relapses, and FFP appearing numerically superior to surgery in this cohort. In this first series of low dose RT for PCSMLPD, 4 Gy in 2 fractions appears an excellent treatment option, offering durable disease control, no acute toxicities and convenient treatment time of only 2 days. Invited Speaker

3379

Management of older patients with skin cancer: Are we overtreating?

Anita O'Donovan

Trinity College Dublin, Applied Radiation Therapy Trinity (ARTT), Dublin, Ireland

Abstract:

Skin cancer is the most common cancer and is rapidly increasing worldwide. Older adults are at much higher risk of developing skin cancer due to their lifetime cumulative exposure to UV light, which is the predominant risk factor for the disease. There are many age-related considerations to take into account when managing skin cancer in an older patient population and making treatment decisions. First of all, older adults are a heterogeneous group, with differing capacities when it comes to treatment options and tolerability. Frailty is the formal clinical measure of this reserve capacity, however frailty assessment does not form part of the routine clinical workup of older patients with cancer. It is estimated that as many as half of all patients with cancer present with pre-frailty or frailty. This necessitates a more personalised approach, guided by a baseline geriatric assessment in order to put in place appropriate interventions and to guide patient care. When considering the subject of undertreatment versus overtreatment, it must also be acknowledged that there is a lack of evidence to support current treatment paradigms in skin cancer. This is partly due to the historical lack of investment in research in this field, particularly for older adults. In general, older patients are underrepresented in oncology clinical trials and therefore tailored clinical guidelines are lacking. As a result, there is potential for both over- and under-treatment, which again underlines the importance of adequate frailty assessment to support decision-making.

Age alone should not be the main guiding factor in deciding on the best therapeutic approach, and there are a variety of treatment options available.

This presentation will cover:

• Epidemiology of skin cancer in older adults • What is different about older patients, with a focus on frailty and its impact on management • The lack of evidence base and investment in this patient group to date, which limits our full understanding of the impact of age • Age alone should not guide management. There are many options available that need to be tailored to the unique needs of the older patient, including surveillance • International Society of Geriatric Oncology (SIOG) guidelines on the management of skin cancer in older adults