Clinical Outcomes in Elderly Patients Treated for Oral Cavity Squamous Cell Carcinoma

Chen, Jie Jane; Shah, Jennifer; Harris, Jeremy P.; Bui, Timothy T.; Schaberg, Kurt B.; Kong, Christina S.; Kaplan, Michael; Divi, Vasu; Schoppy, David W.; Le, Quynh Thu; Hara, Wendy

doi:10.1016/j.ijrobp.2017.03.017

Cited by 10 publications

(17 citation statements)

References 17 publications

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“…Our results are highly comparable to those of Sommers et al 11 who reported OS at 5 years to be 45.5% in patients aged 70 and older (mean age = 76.6 years) treated with definitive radiotherapy for mHNSCC. Similarly, Chen et al 12 reported a 2-year OS of 57% in patients aged 70 years and older (median age = 80 years) treated with surgery with or without adjuvant radiotherapy for oral cavity SCC. These results, like ours, indicate that curative intent treatment, with its associated toxicity, may be justifiable in this age group.…”

Section: Discussionmentioning

confidence: 85%

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

et al. 2019

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Background: Elderly patients with mucosal squamous cell carcinomas of the head and neck (mHNSCC) represent a challenging clinical dilemma. Methods: A retrospective review was performed of patients ≥75 years, treated with curative-intent radiotherapy for mHNSCC in two quaternary Sydney hospitals between 2007 and 2017. Results: Ninety-five patients met inclusion criteria. The median age was 79 years (75-94). Patients received radiotherapy alone (n = 24), concurrent chemoradiotherapy (n = 22), surgery and adjuvant radiotherapy (n = 45), or surgery with adjuvant chemoradiotherapy (n = 4). Median follow-up was 4.5 years, median overall survival (OS) was 3.8 years, and 2-year and 5-year OS were 56% and 43%, respectively. Eastern Cooperative Oncology Group performance status of ≥2 (P < .001) was a statistically significant predictor of reduced OS. Thirty-four patients (36%) required hospitalization, 5 (5%) did not complete radiotherapy, and 9 (9%) were feeding tube dependent beyond 6 months. Conclusions: Appropriately selected elderly patients can achieve durable outcomes from curative intent radiotherapy with acceptable treatment toxicity. K E Y W O R D Selderly, geriatric oncology, head and neck cancer, performance status, radiotherapy

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Section: Discussionmentioning

confidence: 85%

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

et al. 2019

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“…Our findings suggest that CCRT is not associated with better survival than RT alone after controlling for covariates of age, sex, comorbidities, medical center with larger patient volume, clinical stage, alcohol consumption, betel nut use, and cigarette smoking. Moreover, surgery in elderly patients with LA-OCSCC was discovered to be valuable and resulted in lower all-cause mortality than definitive CCRT; this may have been because elderly patients with LA-OCSCC may live to experience disease progression after receiving CCRT instead of surgery [33]. However, evidence of the benefits of surgery in the oldest (>80 years) patients with LA-OCSCC remains elusive, and this treatment should be investigated prospectively.…”

Section: Discussionmentioning

confidence: 99%

Outcomes for Elderly Patients Aged 70 to 80 Years or Older with Locally Advanced Oral Cavity Squamous Cell Carcinoma: A Propensity Score–Matched, Nationwide, Oldest Old Patient–Based Cohort Study

Shia

Qin

Lin

et al. 2020

Cancers

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Purpose: Although clinicians encounter patients aged ≥70 years with locally advanced oral cavity squamous cell carcinoma (LA-OCSCC), no evidence is available to facilitate decision making regarding treatment for this elderly population. Methods: We selected elderly (≥70 years) patients from the Taiwan Cancer Registry database who had received a diagnosis of LA-OCSCC. Propensity score matching was performed. Cox proportional hazards model curves were used to analyze all-cause mortality in patients in different age groups receiving different treatments. Results: The matching process yielded a final cohort of 976 patients in concurrent chemoradiotherapy (CCRT), non-treatment, radiotherapy (RT) alone, and surgery cohorts who were eligible for further analysis. After stratified analysis, the adjusted hazard ratios (aHRs) (95% confidence intervals [CIs]) derived for surgery, RT alone, and non-treatment compared with CCRT were 0.66 (0.52 to 0.83), 1.02 (0.81 to 1.28), and 1.52 (1.21 to 1.91), respectively, in patients aged 70 to 80 years. In the oldest patients (aged >80 years), multivariate analysis indicated that the results of surgery or RT alone were nonsignificant compared with those of CCRT. The aHR (95% CI) derived for the highest mortality was 1.81 (1.11 to 2.40) for non-treatment compared with CCRT. Conclusions: Surgery for elderly patients with LA-OCSCC is associated with a significant survival benefit, but the association is nonsignificant in the oldest elderly patients. No survival differences were observed between RT alone and CCRT in these elderly patients. Non-treatment should not be an option for these patients.

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“…The CCI scoring system comprises many evaluation factors; therefore, some studies have suggested the use of a modified or weighted CCI scoring system in treatment for various types of cancer [23][24][25] . HN-CCI, a simplified CCI, is composed of six identified conditions that contribute to overall survival and enables evaluation of preoperative performance status to facilitate a decision regarding the treatment plan in elderly patients with oral cancer 18,26 . (Table 1)…”

Section: Introductionmentioning

confidence: 99%

“…In addition to CCI, various performance status systems exist: Adult Comorbidity Evaluation-27 (ACE-27), Karnofsky performance index, American Society of Anesthesiologists (ASA) classification of physical status, and ECOG performance status 13,17,[27][28][29] . (Table 2) Hazard ratio (HR) for overall survival will be 4.26 when ECOG score is higher than 2 18 . Bøje et al 26 reported that HR was almost 2 at CCI ≥2.…”

Section: Introductionmentioning

confidence: 99%

Factors to consider for surgical in elderly patients with oral cancer

Lee

Kim

2021

JKAOMS

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Clinical Outcomes in Elderly Patients Treated for Oral Cavity Squamous Cell Carcinoma

Cited by 10 publications

References 17 publications

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

Outcomes for Elderly Patients Aged 70 to 80 Years or Older with Locally Advanced Oral Cavity Squamous Cell Carcinoma: A Propensity Score–Matched, Nationwide, Oldest Old Patient–Based Cohort Study

Factors to consider for surgical in elderly patients with oral cancer

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