Review of current best practice in radiation oncology for older adults with cancer: Updates from the International Society of Geriatric Oncology (SIOG) Task Force

Radiotherapy (RT) is a vital and effective cancer treatment that contributes to over 40 % of cancer cures. RT is also fundamental to palliation and improving quality of life in almost all advanced malignancies. The specialty of radiation oncology has undergone dramatic technological advances over the past decade with increasing sophistication of treatment planning and delivery leading to improved cure rates and reduced side effects. For older adults with cancer, RT represents an excellent treatment option due to its effectiveness, limited systemic toxicity, convenience, and tolerability. Advanced techniques such as stereotactic body radiotherapy (SBRT) and hypofractionated regimens are highly effective non-invasive treatment options that may avoid the need for hospital admission, the potential mortality and morbidity of surgery and/or the toxicities of systemic therapy. Historically, the role of RT for older adults has not been comprehensively assessed or defined due to the limited recruitment of older adults to clinical trials. Fortunately, the increasing number of RT trials tailored to specifically explore outcomes for older people is expanding the body of evidence for this priority research area. This updated expert position paper from the SIOG (International Society of Geriatric Oncology) Task Force seeks to provide an overview of the current role of RT in the management of older adults with cancer. The position paper is informed by the geriatric radiation oncology clinical expertise of the SIOG Task Force and emerging evidence in the field since the publication of the original 2014 position paper. Topics covered include the fundamentals of geriatric oncology as applied to radiation oncology, options for dose fractionation schedules and techniques across pre-defined tumor sites and appropriate individualised modifications of regimens in the setting of frailty, discussion of expected tolerability and toxicity (if any) in older adults, and the unique perspectives of care around older adults requiring RT in low- and middle-income countries.