A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation

Abstract

Background:Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers.Aim:The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation.Materials and Methods:Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m2). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome.Results:The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups.Conclusions:Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities.

Assessment of Nasopharyngeal Cancer in Young Patients Aged ≤ 30 Years

“…Younger patients with laryngeal cancer have more advanced disease and poor OS when compared with older counterparts (13). Older patients with advanced oral or oropharyngeal cancers have similar survival rates as young patients; however, older patients have higher rates of therapy-related toxicities (14). The increase in the numbers of cancer patients with poor prognoses has increased the overall cancer burden in society.…”

Therapeutic Options in Unresectable Oral Squamous Cell Carcinoma: A Systematic Review

“… 19 , 24 , 26 , 28 , 32 , 33 , 35 , 40–42 , 50 The number of participants for each intervention group varied from 16 27 to 256 42 people. Twelve studies 19 , 21 , 24–26 , 28 , 32 , 33 , 35 , 40 , 42 , 50 only focused on patients with clinical stage III/IV oral cancer, whereas two studies 27 , 41 also included other clinical stages. The main outcomes assessed were OS and LRC, which were evaluated in 10 24–28 , 32 , 33 , 35 , 40 , 41 , 50 and seven 24–26 , 33 , 35 , 40 , 41 studies, respectively ( Table 1 ).…”

“…Among those studies in favor of CCRT, the 5-year OS and LRC rates ranged from 22% 24 to 76%, 35 and 49% 24 to 90%, 35 respectively. Overall, cisplatin remains as the main chemotherapeutic drug used in CCRT for unresectable oral cancer treatment; three studies 19 , 21 , 24 used cisplatin plus RT up to 70 Gy, one study 50 used cisplatin or carboplatin plus RT up to 70 Gy, while two studies 27 , 32 used the S-1 (Taiho Pharmaceutical, Tokyo, Japan) plus RT. Biswas 19 evaluated the use of cisplatin plus RT 70 Gy between younger (<40 years) and older (>40 years) adults, concluding that there is a similar overall response (63.5% vs 65.9%) between these groups; thus, CCRT can be used both for young as the elderly population.…”

“…All selected studies were published in English language between 2011 and 2020. There were 15 retrospective cohort studies, 22,[24][25][26]28,34,[36][37][38][39][40][41][42]47,50 eight were prospective cohort studies, 19,23,29,32,33,35,44,46 six were RCTs, 18,21,27,30,31,43 four were clinical trials, 20,45,48,49 and none was case-control study. The sample size varied from 16 27 to 976 42 participants.…”

“…The sample size varied from 16 27 to 976 42 participants. There were eight studies from India, 19,21,34,[36][37][38]43,46 six from Japan, 26,27,32,33,40,45 four from Taiwan, 20,42,47,48 three from the United States, 25,35,41 two from China, 30,31 two from Pakistan, 28,49 while the other studies were one from each of the following: Canada, 50 Hungary, 44 Italy, 23 Iran, 29 Spain, 39 The Netherlands, 24 Thailand, 22 and Ukraine. 18 Only 14 studies 20,22,24,26,28,[34][35][36][37][38][41][42][43]46 reported oral cancer risk factors, such as smoking, alcohol consumption and betel chewing.…”