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Frailty profile precluding standard cisplatin-based chemoradiation in cervical cancer: EC...

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IDRF-CERVICAL-FRAILTY-AGE
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-CERVICAL
FuentesSRC-ESMO-CERVICAL-2024 SRC-NCCN-CERVICAL-2025

Origen de la bandera roja

DefiniciónFrailty profile precluding standard cisplatin-based chemoradiation in cervical cancer: ECOG ≥3, OR (age ≥75 with Charlson ≥3), OR composite (age ≥70 + albumin <3.0 + ≥2 comorbidities). Routes to carboplatin-CRT substitution or RT-alone (less efficacy but tolerable).
Dirección clínicadecreciente
Categoríaedad de fragilidad

Lógica de activación

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 70
        },
        {
          "comparator": "<",
          "finding": "albumin_g_dl",
          "threshold": 3.0
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notas

Cisplatin radiosensitizer requires CrCl ≥60 — elderly often fall below. Carboplatin-CRT (AUC 2 weekly) is acceptable substitute when cisplatin intolerable, though less radiosensitizing per non-randomized comparisons. Frail elderly with severe comorbidity: RT-alone (≥80 Gy total to point A via brachytherapy boost) preserves curative intent without chemo toxicity — 5y OS lower (~50% vs ~70% for CRT in stage III) but meaningful palliation. Avoid bevacizumab in elderly with HTN / vascular disease.

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