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Inicio Medicina Clínica (English Edition) Frailty and vulnerability as predictors of radiotoxicity in older adults: A long...
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Vol. 149. Issue 8.
Pages 325-330 (October 2017)
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Vol. 149. Issue 8.
Pages 325-330 (October 2017)
Original article
Frailty and vulnerability as predictors of radiotoxicity in older adults: A longitudinal study in Peru
Fragilidad y vulnerabilidad como predictores de radiotoxicidad en adultos mayores: un estudio longitudinal en Perú
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Fernando M. Runzer-Colmenaresa, Diego Urrunaga-Pastorb,
Corresponding author
, Luis G. Aguirreb, C. Mahony Reategui-Riverac, José F. Parodia, Alvaro Taype-Rondana
a Centro de Investigación del Envejecimiento, Universidad de San Martín de Porres, Lima, Peru
b Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martín de Porres, Lima, Peru
c Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Universidad Nacional Mayor de San Marcos, Lima, Peru
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Tables (4)
Table 1. Characteristics of the study sample and bivariate analysis (n=181).
Table 2. Classification of the radiotoxic effects found.
Table 3. Cox regression model to evaluate the development of radiotoxicity, in frailty and vulnerability scales with usual cut-off points.
Table 4. Area under the curve, cut-off points, sensitivity, specificity, and Youden index of the frailty and vulnerability markers as predictors of radiotoxicity.
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Abstract
Background and objective

To assess the association between frailty/vulnerability and the development of radiotoxicity in older adults at a hospital in Peru.

Material and methods

Cohort study that included patients with cancer with medical recommendation of radiotherapy, who attended the outpatient department of geriatrics at Naval Medical Center (Lima, Peru) between 2013 and 2015. Before receiving radiation therapy sessions, we measured frailty using Fried phenotype, and vulnerability using VES-13 and G-8 scales. During radiotherapy, we determined the development of radiotoxicity. ROC curves and crude/adjusted Cox regression models were prepared to evaluate the association between the frailty/vulnerability scales and the development of radiotoxicity respectively.

Results

From a total of 181 patients (mean age: 78.1 years, all males), 33 (18.2%) developed some type of radiotoxicity. The appearance of radiotoxicity was higher in patients with frailty or vulnerability compared with those without these conditions, according to the usual cutoff points of Fried phenotype (10.9% versus 41.9%), VES-13 (5.0% versus 63.4%) and G-8 (5.6% versus 67.6%). The area under the curve was 0.61 (0.55–0.65) for the Fried phenotype, 0.79 (0.69–0.86) for the VES-13, and 0.86 (0.58–0.89) for the G-8.

Conclusions

We found an association between frailty/vulnerability and the development of radiotoxicity. The G-8 and the VES-13 scales had a better area under the curve than Fried phenotype, suggesting that those could be useful tools when deciding the dose of radiotherapy in geriatric patients.

Keywords:
Geriatric assessment
Frail elderly
Cancer
Radiotherapy
Toxicity
Resumen
Fundamento y objetivo

Evaluar la asociación entre fragilidad/vulnerabilidad y el desarrollo de radiotoxicidad en adultos mayores en un hospital de Perú.

Material y métodos

Cohorte que incluyó pacientes con diagnóstico de cáncer e indicación de radioterapia que acudieron al servicio ambulatorio de Geriatría del Centro Médico Naval (Lima, Perú) entre 2013 y 2015. Antes de recibir radioterapia se evaluó la fragilidad usando el fenotipo de Fried, y se evaluó la vulnerabilidad usando las escalas VES-13 y G-8. Durante la radioterapia, se determinó el desarrollo de radiotoxicidad. Se elaboraron curvas ROC y modelos de regresión de Cox crudos y ajustados para evaluar la asociación entre las escalas de fragilidad/vulnerabilidad y el desarrollo de radiotoxicidad.

Resultados

De un total de 181 pacientes (edad media: 78,1 años, todos del sexo masculino), 33 (18,2%) presentaron algún tipo de radiotoxicidad. La aparición de radiotoxicidad fue mayor en los pacientes con fragilidad o vulnerabilidad en comparación con aquellos sin estas condiciones, según los puntos de corte usuales del fenotipo de Fried (10,9% versus 41,9%), del VES-13 (5,0% versus 63,4%) y del G-8 (5,6% versus 67,6%). El área bajo la curva fue 0,61 (0,55-0,65) para el fenotipo de Fried, 0,79 (0,69-0,86) para el VES-13, y 0,86 (0,58-0,89) para el G-8.

Conclusiones

Se encontró una asociación entre fragilidad/vulnerabilidad y el desarrollo de radiotoxicidad. El G-8 y el VES-13 tuvieron mayor área bajo la curva que el fenotipo de Fried, lo que sugiere que podrían ser herramientas útiles al momento de decidir la dosis de radioterapia en pacientes geriátricos.

Palabras clave:
Evaluación geriátrica
Anciano frágil
Cáncer
Radioterapia
Toxicidad

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