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Review article: Biomedical intelligence

Vol. 144 No. 5152 (2014)

General management of nonagenarian patients: a review of the literature

  • Romain Rivoirard
  • Cyrus Chargari
  • Jane-Chloé Trone
  • Alexander T Falk
  • Jean-Baptiste Guy
  • Houda Eddekkaoui
  • Rima Lahmar
  • Cécile Pacaut
  • Benoite Mery
  • Avi Assouline
  • Pierre Auberdiac
  • Guillaume Moriceau
  • Regis Gonthier
  • Aline Guillot
  • Yacine Merrouche
  • Nicolas Magné
DOI
https://doi.org/10.4414/smw.2014.14059
Cite this as:
Swiss Med Wkly. 2014;144:w14059
Published
15.12.2014

Summary

The number of nonagenarian people in the world is steadily growing. This phenomenon will increase in future years: in 2050, world population prospects estimate 71.16 million people aged 90 years or older. The two main causes of death among people aged 85 years or more in Europe in 2003 were cardiovascular and cerebrovascular diseases and cancers. However, the elderly are often excluded from clinical trials; they are underrepresented in clinical registries and especially nonagenarians. Care (medical, surgical, oncology) of these very elderly is currently insufficiently based on scientific recommendations. For the physician, the choice to treat or not to treat very elderly patients (for fear of side effects) is difficult. Oncology is particularly affected by this problem. Here we review these different fields of internal medicine management of nonagenarian patients with a special focus on oncology and on comprehensive geriatric assessment as a base for all care decision taking.

References

  1. Adveev A, Eremenko T, Festy P, et al. Populations and Demographic Trends of European Countries (1980–2010). Population 2011; vol.66 nº1: 9–130.
  2. Lafortune G, De Looper M, Balestat G, et al. Health at a Glance 2009: OECD Indicators. Paris: OECD Publishing: 2009.
  3. United Nations, Department of Economic and Social Affairs, Population Division, Population Estimates and Projections Section. World Population Prospects, the 2010 Revision. Population by Age Groups-Both Sexes. Estimates, 1950–2010. [cited 23/05/2013]. Available fromURL: http://esa.un.org/wpp/Excel-Data/population.htm
  4. United Nations, Department of Economic and Social Affairs, Population Division, Population Estimates and Projections Section. World Population Prospects, the 2010 Revision. Population by Age Groups-Both Sexes. Medium-fertility variant, 2010–2100 [cited 23/05/2013]. Available from URL: http://esa.un.org/wpp/ExcelData/population.htm
  5. Niederlaender E. Causes of death in the EU. Eurostat-Statistics in Focus 2006; Issue number 10/2006: 1–12.
  6. Desbat NH, Levy A, Auberdiac P, et al. Curative-intended treatment of squamous cell anal carcinoma in elderly adults. J Am Geriatr Soc. 2012;60:1993–4.
  7. Auberdiac P, Chargari C, Cartier L, et al. Exclusive radiotherapy and concurrent endocrine therapy for the management of elderly breast cancer patients: case study and review of hypo fractionated schemes. Cancer Radiother. 2011;15:723–7.
  8. Chaïbi P, Magné N, Breton S, et al. Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients. Crit Rev Oncol Hematol. 2011;79:302–7.
  9. Magné N, Mancy NC, Chajon E, et al. Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol. 2009;91:197–201.
  10. Magné N, François E, Broisin L, et al. Palliative 5–fluorouracil-based chemotherapy for advanced colorectal cancer in the elderly: results of a 10–year experience. Am J Clin Oncol. 2002;25:126–30.
  11. Puts MT, Hardt J, Monette J, et al. Use of Geriatric Assessment for Older Adults in the Oncology Setting: A Systematic Review. JNCI Journal of the National Cancer Institute 2012;104:1134–64.
  12. Hamaker ME, Jonker JM, de Rooij SE, et al. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Lancet Oncol. 2012;13:437–44.
  13. Biondi Zoccai G, Abbate A, D'Ascenzo F, et al. Percutaneous coronary intervention in nonagenarians: pros and cons. J Geriatr Cardiol. 2013;10:82–90.
  14. Mandawat A, Mandawat A, Mandawat MK. Percutaneous coronary intervention after ST-segment elevation myocardial infarction in nonagenarians: use rates and in-hospital mortality. J Am Coll Cardiol. 2013;61:1207–8.
  15. Rigattieri S, Cera M, Sciahbasi A, et al. Primary percutaneous coronary intervention in nonagenarians: six-month outcomes from a single-centre registry. J Invasive Cardiol. 2013;25:242–5.
  16. Khurana D, Kumari B, Rajan R, et al. Efficacy and safety of thrombolysis in patients. Neurol India. 2012;60:686–7.
  17. Sarikaya H, Arnold M, Engelter ST, et al. Intravenous thrombolysis in nonagenarians aged 80 or more with major ischemic stroke: special reference to nonagenarians with ischemic stroke. Stroke. 2011;42:1967–70.
  18. Steed H. Endoscopic retrograde cholangio pancreatography in nonagenarians: a decades-long experience in a single centre. J Am Geriatr Soc. 2011;59:2387–8.
  19. Christoforidis E, Vasiliadis K, Blouhos K, et al. Feasibility of therapeutic endoscopic retrograde cholangiopancreatography for bile duct stones in nonagenarians: a singleunit audit. J Gastrointestin Liver Dis. 2008;17:427–32.
  20. Bridges CR, Edwards FH, Peterson ED, et al. Cardiac surgery in nonagenarians and centenarians. J Am Coll Surg. 2003;197:347–56; discussion 356–7.
  21. Assmann A, Minol JP, Mehdiani A, et al. Cardiac surgery in nonagenarians: not only feasible, but also reasonable? InteractCardiovasc Thorac Surg. 2013;1–4.
  22. Caceres M, Cheng W, De Robertis M, et al. Survival and quality of life for nonagenarians after cardiac surgery. Ann Thorac Surg. 2013;95:1598–602.
  23. Baker JF, Stoyanov V, Shafqat A, et al. Total joint arthroplasty in nonagenarians-a retrospective review of complications and resource use. Acta Orthop Belg. 2012;78:745–50.
  24. Karuppiah SV, Banaszkiewicz PA, Ledingham WM. The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population. IntOrthop. 2008;32:339–43. Epub 2007 Feb 28.
  25. Rubenstein LZ, Josephson KR, Wieland GD, et al. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984;311:1664–70.
  26. Rubenstein LZ, Siu AL, Wieland D. Comprehensive geriatric assessment: toward understanding its efficacy. Aging (Milano). 1989;1:87–98.
  27. Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta analysis of controlled trials. Lancet. 1993;342:1032–6.
  28. Wieland D, Ferrucci L. Multidimensional Geriatric Assessment: Back to the Future. J Gerontol A, Biol Sci Med Sci. 2008;63:272–74.
  29. Hurria A. We need a geriatric assessment for oncologists. Nat Clin Pract Oncol. 2006;3:642–3.
  30. Mohile SG, Magnuson A. Comprehensive geriatric assessment in oncology. Interdiscip Top Gerontol. 2013;38:85–103.
  31. Balducci L, Stanta G. Cancer in the frail patient. A coming epidemic. Hematol Oncol Clin North Am. 2000;14:235–50, xi.
  32. Antonsen L, Jensen LO, Terkelsen CJ, et al. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: From the Western Denmark heart registry. Catheter Cardiovasc Interv. 2013;81:912–9.
  33. Chait R, Zad O, Ramineni R, et al. Midterm outcomes and quality of life following percutaneous coronary intervention in nonagenarians. Am J Cardiol. 2011;107:1609–12.
  34. Danzi GB, Centola M, Pomidossi GA, et al. Usefulness of primary angioplasty in nonagenarians with acute myocardial infarction. Am J Cardiol. 2010;106:7703.
  35. From AM, Rihal CS, Lennon RJ, et al. Temporal trends and improved outcomes of percutaneous coronary revascularization in nonagenarians. JACC Cardiovasc Interv. 2008;1:692–8.
  36. Hendler A, Katz M, Gurevich Y, et al. 30–day outcome after percutaneous coronary angioplasty in nonagenarians: feasibility and specific considerations in different clinical settings. J Invasive Cardiol. 2011;23:521–4.
  37. Ionescu CN, Amuchastegui M, Ionescu S, et al. Treatment and outcomes of nonagenarians with ST-elevation myocardial infarction. J Invasive Cardiol. 2010;22:474–8.
  38. Kondur AK, Pawan H, Kaur R, et al. Coronary angiographic findings and results of percutaneous coronary intervention (PCI) in nonagenarians: a single tertiary care centre experience. J Am Coll Cardiol. 2010;55:A209.
  39. Koutouzis M, Grip L, Matejka G, et al. Primary percutaneous coronary interventions in nonagenarians. Clin Cardiol. 2010;33:157–61.
  40. LeBude B, Fischman D, Savage M, et al. Safety, effectiveness, and outcomes of cardiac catheterization in nonagenarians. Am J Cardiol. 2012;110:1231–3.
  41. Lee MS, Zimmer R, Pessegueiro A, et al. Outcomes of nonagenarians who undergo percutaneous coronary intervention with drug-eluting stents. Catheter Cardiovasc Interv. 2008;71:526–30.
  42. Lemesle G, Bonello L, De Labriolle A, et al. Impact of bivalirudin use on outcomes in nonagenarians undergoing percutaneous coronary intervention. J Interv Cardiol. 2009;22:61–7.
  43. Moreno R, Salazar A, Bañuelos C, et al. Effectiveness of percutaneous coronary interventions in nonagenarians. Am J Cardiol. 2004;94:1058–60.
  44. Sillano D, Resmini C, Meliga E, et al. A Retrospective multicentre observational study of the interventional management of coronary disease in the very elderly: The NINETY (NonagenarIaNs trEated by means of sTents studY). Catheter Cardiovasc Interv. 2012 Apr 19.
  45. Parikh R, Chennareddy S, Debari V, et al. Percutaneous coronary interventions in nonagenarians: in-hospital mortality and outcome at one year follow-up. Clin Cardiol. 2009;32:16–21.
  46. Rekik S, Brunet J, Bayet G, et al. Unprotected left main angioplasty in nonagenarians: clinical characteristics, procedural features and outcome: a case series study. J Invasive Cardiol. 2010;22:231–4.
  47. Salinas P, Galeote G, Martin-Reyes R, et al. Primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction in nonagenarian patients: results from a Spanish multicentre registry. EuroIntervention. 2011;6:1080–4.
  48. Teplitsky I, Assali A, Lev E, et al. Results of percutaneous coronary interventions in patients > or =90 years of age. CatheterCardiovasc Interv. 2007;70:937–43.
  49. Wu YJ, Hou CJ, Chou YS, et al. Percutaneous coronary intervention in nonagenarians. Acta Cardiol Sin. 2004;20:73–82.
  50. Skolnick AH, Alexander KP, Chen AY, et al. Characteristics, management, and outcomes of 5,557 patients age > or =90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol. 2007;49:1790–7.
  51. Koster NK, Reddy YM, Schima SM, et al. Gender-specific echocardiographic findings in nonagenarians with cardiovascular disease. Am J Cardiol. 2010;105:273–6.
  52. Seo KW, Kim EY, Kim JE, Cho EJ, et al. The impact of mitral annular calcification on left ventricular function in nonagenarians. Korean Circ J. 2010;40:260–5.
  53. Van Bemmel T, Delgado V, Bax JJ, et al. Impact of valvular heart disease on activities of daily living of nonagenarians: the Leiden 85–plus study a population based study. BMC Geriatr. 2010;10:17.
  54. Mateen FJ, Nasser M, Spencer BR, et al. Outcomes of intravenous tissue plasminogen activator for acute ischemic stroke in patients aged 90 years or older. Mayo Clin Proc. 2009;84:334–8.
  55. Mateen FJ, Buchan AM, Hill MD; CASES Investigators. Outcomes of thrombolysis for acute ischemic stroke in octogenarians versus nonagenarians. Stroke. 2010;41:1833–5.
  56. Scheitz JF, Audebert HJ, Nolte CH. Letter by Scheitz et al. regarding article, “Intravenous thrombolysis in nonagenarians with ischemic stroke”. Stroke. 2011;42:e563; author reply e564.
  57. Hui CK, Liu CL, Lai KC, et al. Outcome of emergency ERCP for acute cholangitis in patients 90 years of age and older. Aliment Pharmacol Ther. 2004;19:1153–8.
  58. Katsinelos P, Paroutoglou G, Kountouras J, et al. Efficacy and safety of therapeutic ERCP in patients 90 years of age and older. Gastrointest Endosc. 2006;63:41723.
  59. Mitchell RM, O'Connor F, Dickey W. Endoscopic retrograde cholangiopancreatography is safe and effective in patients 90 years of age and older. J Clin Gastroenterol. 2003;36:72–4.
  60. Rodríguez-González FJ, Naranjo-Rodríguez A, Mata-Tapia I, et al. ERCP in patients 90 years of age and older. Gastrointest Endosc. 2003;58:220–5.
  61. Sugiyama M, Atomi Y. Endoscopic sphincterotomy for bile duct stones in patients 90 years of age and older. Gastrointest Endosc. 2000;52:187–91.
  62. Tsilimparis N, Perez S, Dayama A, et al. Age-stratified results from 20,095 aortoiliac aneurysm repairs: should we approach octogenarians and nonagenarians differently? J Am Coll Surg. 2012;215:690–701.
  63. Baril DT, Palchik E, Carroccio A, et al. Experience with endovascular abdominal aortic aneurysm repair in nonagenarians. J Endovasc Ther. 2006;13:330–7.
  64. Geisbüsch P, Katzen BT, Tsoukas AI, et al. Endovascular repair of infrarenal aortic aneurysms in octogenarians and nonagenarians. J Vasc Surg. 2011;54:1605–13.
  65. Prenner SB, Turnbull IC, Serrao GW, et al. Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenarians. J Vasc Surg. 2011;54:28794.
  66. Goldstein LJ, Halpern JA, Rezayat C, et al. Endovascular aneurysm repair in nonagenarians is safe and effective. J Vasc Surg. 2010;52:1140–6.
  67. Jim J, Sanchez LA, Sicard GA, et al. Acceptable risk but small benefit of endovascular aneurysm repair in nonagenarians. Ann Vasc Surg. 2010;24:4416.
  68. Karnwal A, Lippmann M, Julka IS, et al. Endovascular abdominal aneurysm repair in nonagenarians: never beyond the limits. Tex Heart Inst J. 2009;36:632.
  69. Lichtman JH, Jones SB, Wang Y, et al. Postendarterectomy mortality in octogenarians and nonagenarians in the USA from 1993 to 1999. Cerebrovasc Dis. 2010;29:154–61.
  70. Teso D, Edwards RE, Frattini JC, et al. Safety of carotid endarterectomy in 2,443 elderly patients: lessons from nonagenarians – are we pushing the limit? J Am Coll Surg. 2005;200:734–41.
  71. Hingorani A, Ascher E, Schutzer R, et al. Carotid endarterectomy in octogenarians and nonagenarians: is it worth the effort? Acta Chir Belg. 2004;104:384–7.
  72. Durward QJ, Ragnarsson TS, Reeder RF, et al. Carotid endarterectomy in nonagenarians. Arch Surg. 2005;140:625–8.
  73. Killeen KL, Wagner WH, Cossman DV, et al. Carotid reconstruction in nonagenarians: is surgery a viable option? Ann Vasc Surg. 2008;22:190–4.
  74. Akin I, Kische S, Paranskaya L, et al. Morbidity and mortality of nonagenarians undergoing CoreValve implantation. BMC Cardiovasc Disord. 2012;12:80.
  75. Bacchetta MD, Ko W, Girardi LN, et al. Outcomes of cardiac surgery in nonagenarians: a 10–year experience. Ann Thorac Surg. 2003;75:1215–20.
  76. Blanche C, Matloff JM, Denton TA, et al. Cardiac operations in patients 90 years of age and older. Ann Thorac Surg. 1997;63:1685–90.
  77. Easo J, Hölzl PP, Horst M, et al. Cardiac surgery in nonagenarians: pushing the boundary one further decade. Arch Gerontol Geriatr. 2011;53:229–32.
  78. Edwards MB, Taylor KM. Outcomes in nonagenarians after heart valve replacement operation. Ann Thorac Surg. 2003;75:830–4.
  79. Guilfoyle MR, Drain AJ, Khan A, et al. Cardiac surgery in nonagenarians: single-centre series and review. Gerontology. 2010;56:378–84.
  80. Hovanesyan A, Moon MR, Rich MW. Cardiac surgery in nonagenarians. J Cardiovasc Surg. (Torino) 2007;48:757–60.
  81. Levy Praschker BG, Leprince P, Bonnet N, et al. Cardiac surgery in nonagenarians: hospital mortality and long-term follow-up. Interact Cardiovasc Thorac Surg. 2006;5:696–9.
  82. Mandawat A, Curtis JP, Mandawat A, et al. Safety of pacemaker implantation in nonagenarians: an analysis of the healthcare cost and utilization project-nationwide inpatient sample. Circulation. 2013;127:1453–65,1465 e1–2.
  83. Miller DJ, Samuels LE, Kaufman MS, et al. Coronary artery bypass surgery in nonagenarians. Angiology. 1999;50:613–7.
  84. Samuels LE, Sharma S, Morris RJ, et al. Cardiac surgery in nonagenarians. J Card Surg. 1996;11:121–7.
  85. Speziale G, Nasso G, Barattoni MC, et al. Operative and middle-term results of cardiac surgery in nonagenarians: a bridge toward routine practice. Circulation. 2010;121:208–13.
  86. Ullery BW, Peterson JC, Milla F, et al. Cardiac surgery in select nonagenarians: should we or shouldn't we? Ann Thorac Surg. 2008;85:854–60.
  87. Yamamoto M, Meguro K, Mouillet G, et al. Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged ≥90 years versus <90 years. Am J Cardiol. 2012;110:1156–63.
  88. Alarcón T, González-Montalvo JI, Bárcena A, et al. Further experience of nonagenarians with hip fractures. Injury. 2001;32:555–8.
  89. Alfonso DT, Howell RD, Strauss EJ, et al. Total hip and knee arthroplasty in nonagenarians. J Arthroplasty. 2007;22:807–11.
  90. Baker JF, Stoyanov V, Shafqat A, et al. Total joint arthroplasty in nonagenarians-a retrospective review of complications and resource use. Acta Orthop Belg. 2012;78:745–50.
  91. Formiga F, Lopez-Soto A, Sacanella E, et al. Mortality and morbidity in nonagenarian patients following hip fracture surgery. Gerontology. 2003;49:41–5.
  92. Gregory JJ, Starks I, Aulakh T, et al. Five-year survival of nonagenarian patients undergoing total hip replacement in the United Kingdom. J Bone Joint Surg Br. 2010;92:1227–30.
  93. Hagino T, Maekawa S, Sato E, et al. Prognosis of proximal femoral fracture in patients aged 90 years and older. J Orthop Surg. (Hong Kong) 2006;14:122–6.
  94. Jennings AG, de Boer P. Should we operate on nonagenarians with hip fractures? Injury. 1999;30:169–72.
  95. Krishnan E, Fries JF, Kwoh CK. Primary knee and hip arthroplasty among nonagenarians and centenarians in the United States. Arthritis Rheum. 2007;57(6):1038–42. Erratum in: Arthritis Rheum 2011;63:1202.
  96. MacCollum MS 3rd, Karpman RR. Approaches to senior care #8. Hip fractures in nonagenarians. Orthop Rev. 1989;18:471–7.
  97. Miller AG, Bercik MJ, Ong A. Nonagenarian hip fracture: treatment and complications. J Trauma Acute Care Surg. 2012;72:1411–5.
  98. Ooi LH, Wong TH, Toh CL, et al. Hip fractures in nonagenarians – a study on operative and non – operative management. Injury. 2005;36:142–7.
  99. Pagnano MW, McLamb LA, Trousdale RT. Primary and revision total hip arthroplasty for patients 90 years of age and older. Mayo Clin Proc. 2003;78:285–8.
  100. Shah MR, Aharonoff GB, Wolinsky P, et al. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma. 2001;15:34–9.
  101. Starks I, Gregory J, Phillips S. Revision hip arthroplasty in nonagenarians. Acta Orthop Belg. 2010;76:766–70.
  102. Torpilliesi T, Bellelli G, Morghen S, et al. Outcomes of nonagenarian patients after rehabilitation following hip fracture surgery. J Am Med Dir Assoc. 2012;13:81.e1–5.
  103. Van de Kerkhove MP, Antheunis PS, Luitse JS, et al. Hip fractures in nonagenarians: perioperative mortality and survival. Injury. 2008;39:244–8. Epub 2007 Oct 22.
  104. Belmar CJ, Barth P, Lonner JH, et al. Total knee arthroplasty in patients 90 years of age and older. J Arthroplasty. 1999;14:911–4.
  105. Joshi AB, Gill G. Total knee arthroplasty in nonagenarians. J Arthroplasty. 2002;17:681–4.
  106. Karuppiah SV, Banaszkiewicz PA, Ledingham WM. The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population. Int Orthop. 2008;32:339–43. Epub 2007 Feb 28.
  107. Pagnano MW, McLamb LA, Trousdale RT. Total knee arthroplasty for patients 90 years of age and older. Clin Orthop Relat Res. 2004;418:179–83.
  108. DePalma MJ, Ketchum JM, Frankel BM, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the nonagenarians: a prospective study evaluating pain reduction and new symptomatic fracture rate. Spine (Phila Pa 1976). 2011;36:277–82.
  109. Arenal JJ, de Teresa G, Tinoco C, et al. Abdominal surgery in nonagenarians: short-term results. Surg Today. 2007;37:1064–7.
  110. Blansfield JA, Clark SC, Hofmann MT, et al. Alimentary tract surgery in the nonagenarian: elective vs. emergent operations. J Gastrointest Surg. 2004;8:539–42.
  111. Burns-Cox N, Campbell WB, van Nimmen BA, et al. Surgical care and outcome for patients in their nineties. Br J Surg. 1997;84:496–8.
  112. Pallati PK, Gupta PK, Bichala S, et al. Short-term outcomes of inguinal hernia repair in octogenarians and nonagenarians. Hernia. 2013 Jan 10.
  113. Racz J, Dubois L, Katchky A, et al. Elective and emergency abdominal surgery in patients 90 years of age or older. Can J Surg. 2012;55:322–8.
  114. Rigberg D, Cole M, Hiyama D, et al. Surgery in the nineties. Am Surg. 2000;66:813–6.
  115. Toumi Z, Kesterton A, Bhowmick A, et al. Nonagenarian surgical admissions for the acute abdomen: who benefits? Int J Clin Pract. 2010;64:1570–2.
  116. Warner MA, Hosking MP, Lobdell CM, et al. Surgical procedures among those greater than or equal to 90 years of age. A population-based study in Olmsted County, Minnesota, 1975–1985. Ann Surg. 1988;207:380–6.
  117. McCorkle R, Strumpf NE, Nuamah IF, et al. A specialized home care intervention improves survival among older post-surgical cancer patients. J Am Geriatr Soc. 2000;48(12):1707–13.
  118. Chargari C, Moriceau G, Auberdiac P, et al. Feasibility of radiation therapy in patients 90 years of age and older: a French multicenter analysis. Eur J Cancer. 2014;50(8):1490–7.
  119. Arenal JJ, Tinoco C, Labarga F, et al. Colorectal cancer in nonagenarians. Colorectal Dis. 2012;14:44–7.
  120. Bianchi C, Bianchi T, Bucconi S. Malignant mesothelioma of the pleura in nonagenarian patients. Tumori. 2011;97:156–9.
  121. Britt GJ, Gaughan EM, Nguyen KS, et al. Case series of treatment approaches in fit nonagenarians with stage IV non-small-cell lung cancer. J Thorac Dis. 2011;3:141–3.
  122. Charles AJ Jr, Otley CC, Pond GR. Prognostic factors for life expectancy in nonagenarians with nonmelanoma skin cancer: implications for selecting surgical candidates. J Am Acad Dermatol. 2002;47:419–22.
  123. Damhuis RA, Meurs CJ, Meijer WS. Postoperative mortality after cancer surgery in octogenarians and nonagenarians: results from a series of 5,390 patients. World J Surg Oncol. 2005;9;3:71.
  124. Extermann M, Crane EJ, Boulware D. Cancer in nonagenarians: profile, treatments and outcomes. Crit Rev Oncol Hematol. 2010;75:160–4.
  125. Ikeda H, Ishikura S, Oguchi M, et al. Analysis of 57 nonagenarian cancer patients treated by radical radiotherapy: a survey of eight institutions. Jpn J Clin Oncol. 1999;29:378–81.
  126. Iwata T, Inoue K, Nishiyama N, et al. Lung cancer surgery in nonagenarians. Ann Thorac Cardiovasc Surg. 2008;14:314–8.
  127. Kunitake H, Zingmond DS, Ryoo J, et al. Caring for octogenarian and nonagenarian patients with colorectal cancer: what should our standards and expectations be? Dis Colon Rectum. 2010;53:735–43.
  128. Mir O, Boudou-Rouquette P, Larousserie F, et al. Durable clinical activity of single-agent bevacizumab in a nonagenarian patient with metastatic alveolar soft part sarcoma. Anticancer Drugs. 2012;23:745–8.
  129. Mitsuhashi N, Hayakawa K, Yamakawa M, et al. Cancer in patients aged 90 years or older: radiation therapy. Radiology. 1999;211:829–33.
  130. Moriceau G, Rivoirard R, Pacaut C, et al. Anticancer chemotherapy in nonagenarians [in press]
  131. Oguchi M, Ikeda H, Watanabe T, et al. Experiences of 23 patients > or = 90 years of age treated with radiation therapy. Int J Radiat Oncol Biol Phys. 1998;41:407–13.
  132. Saltzstein SL, Behling CA, Baergen RN. Features of cancer in nonagenarians and centenarians. J Am Geriatr Soc. 1998;46:994–8.
  133. Thompson A, Cone R, Gao H, et al. Is advanced age a barrier to effective cancer treatment? The experience of nonagenarians receiving radiation therapy. Asia Pac J Clin Oncol. 2012;8:255–9
  134. Pavlidis N, Stanta G, Audisio RA. Cancer prevalence and mortality in centenarians: a systematic review. Crit Rev Oncol Hematol. 2012;83(1):145–52.
  135. Chargari C, Moriceau G, Auberdiac P, et al. Analysis of feasibility and toxicity of radiotherapy in centenarians. J Am Geriatr Soc. 2013;61(10):1833–5.

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