Radiotherapy strategies for nonagenarian cancer patients at a tertiary cancer center

PURPOSE: With increasing life expectancy, the clinical role of radiotherapy in cancer patients aged ≥ 90 years warrants systematic evaluation. This study aimed to assess treatment patterns, safety, and outcomes of radiotherapy in the super-elderly at a tertiary cancer center. METHODS: We retrospectively analyzed 119 patients aged ≥ 90 years who underwent radiotherapy between 2007 and 2025. Patient characteristics, treatment modalities, adverse events, and survival were evaluated. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors. RESULTS: The median age was 91 years, and 71% of patients had ECOG performance status (PS) 0–1. Radiotherapy was delivered with curative intent in 69% of cases. Advanced techniques such as stereotactic radiotherapy (SRT), intensity-modulated radiotherapy (IMRT), and brachytherapy (BT) were used in 59% of patients. Hypofractionated schedules (≤ 10 fractions) were applied in 66% of cases. Treatment completion rate was 95%, with grade ≥ 3 adverse events observed in only 3% of patients. Median overall survival was 31.2 months. On multivariate analysis, PS was the only independent prognostic factor for survival. CONCLUSION: Radiotherapy for patients aged ≥ 90 years can be delivered safely and effectively in appropriately selected individuals, particularly when utilizing tailored approaches such as SRT, IMRT, or BT. Even among patients treated with palliative intent, meaningful local control and symptom relief were achievable. These findings suggest that chronological age alone should not preclude the use of radiotherapy; however, clinical decisions should be guided by individual patient factors such as performance status, functional reserve, and overall clinical context.