Magnetic resonance-guided radiotherapy feasibility in elderly cancer patients: proposal of the MASTER scoring system

Abstract

Background: Elderly patients are often excluded from advanced treatments owing to clinical complexity or frailty. Magnetic resonance-guided radiotherapy (MRgRT) represents a new frontier of radiotherapy delivery that can play an important role in the management of these patients.

Aim: To assess MRgRT feasibility in elderly patients, describe their compliance with this treatment, and provide a scoring system for elderly patient selection.

Methods: Patients aged >75 years were enrolled. No restrictions on tumor site, staging, or treatment intent were applied. Patients underwent joint radiation oncology-geriatrics visits to assess the feasibility of MRgRT and to identify the most significant items (i.e. clinical variables) for the setup of a scoring system. The proposed scoring system was then internally validated on a prospectively enrolled cohort of elderly patients who were candidates for MRgRT.

Results: Thirty patients were enrolled between February and March 2018. Their mean age was 81.4 ± 3.4 years (range 75-88). Radiotherapy intent was curative in 26 patients; 14 patients were considered frail at screening tests before radiotherapy. Twelve items were identified as clinically significant for the setup of the MASTER score (MRI-Guided Radiotherapy Selection Elderly Score) score. Validation of the score showed 100% reliability, with no patient discharged after selection.

Conclusions: MRgRT appears to be feasible in elderly patients and the MASTER score is proposed to support clinical decision-making in recommending elderly patients for this technology.

Keywords: Radiotherapy; compliance; elderly; magnetic resonance guided–radiotherapy.