Management of Older Adults with Locally Advanced Head and Neck Cancer

Dickstein, Daniel R.; Lehrer, Eric J.; Hsieh, Kristin; Hotca, Alexandra; Jones, Brianna M.; Powers, Ann; Sharma, Sonam; Liu, Jerry; Gupta, Vishal; Mell, Loren K.; Husain, Zain; Kirke, Diana N.; Misiukiewicz, Krzysztof; Posner, Marshall R.; Genden, Eric M.; Bakst, Richard L.

doi:10.3390/cancers14112809

Cited by 13 publications

(21 citation statements)

References 118 publications

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“…The ideal treatment of older patients with LA-HNSCC is a matter of debate, considering the limited evidence due to underrepresentation or exclusion of older patients from landmark trials. 19 The value of systemic treatment given concomitantly with definitive radiotherapy is a controversial topic, as there was no significant benefit of adding chemotherapy shown in the MACH-NC study. 3 The increasing prevalence of frailty, comorbidities, and the higher vulnerability to chemotherapy-related toxic effects in older adults with HNSCCs may all contribute to the decreasing efficacy of chemoradiation in this population.…”

Section: Discussionmentioning

confidence: 99%

“…In this cohort study of 1044 older adults with LA-HNSCC, chemoradiation was associated with longer survival than radiotherapy alone, whereas the addition of cetuximab to radiotherapy was not associated with improved survival. The ideal treatment of older patients with LA-HNSCC is a matter of debate, considering the limited evidence due to underrepresentation or exclusion of older patients from landmark trials . The value of systemic treatment given concomitantly with definitive radiotherapy is a controversial topic, as there was no significant benefit of adding chemotherapy shown in the MACH-NC study .…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

et al. 2023

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ImportanceThe number of older adults with head and neck squamous cell carcinoma (HNSCC) is increasing, and these patients are underrepresented in clinical trials. It is unclear whether the addition of chemotherapy or cetuximab to radiotherapy is associated with improved survival in older adults with HNSCC.ObjectiveTo examine whether the addition of chemotherapy or cetuximab to definitive radiotherapy is associated with improved survival in patients with locoregionally advanced (LA) HNSCC.Design, Setting, and ParticipantsThe Special Care Patterns for Elderly HNSCC Patients Undergoing Radiotherapy (SENIOR) study is an international, multicenter cohort study including older adults (≥65 years) with LA-HNSCCs of the oral cavity, oropharynx/hypopharynx, or larynx treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between January 2005 and December 2019 at 12 academic centers in the US and Europe. Data analysis was conducted from June 4 to August 10, 2022.InterventionsAll patients underwent definitive radiotherapy alone or with concomitant systemic treatment.Main Outcomes and MeasuresThe primary outcome was overall survival. Secondary outcomes included progression-free survival and locoregional failure rate.ResultsAmong the 1044 patients (734 men [70.3%]; median [IQR] age, 73 [69-78] years) included in this study, 234 patients (22.4%) were treated with radiotherapy alone and 810 patients (77.6%) received concomitant systemic treatment with chemotherapy (677 [64.8%]) or cetuximab (133 [12.7%]). Using inverse probability weighting to attribute for selection bias, chemoradiation was associated with longer overall survival than radiotherapy alone (hazard ratio [HR], 0.61; 95% CI, 0.48-0.77; P &lt; .001), whereas cetuximab-based bioradiotherapy was not (HR, 0.94; 95% CI, 0.70-1.27; P = .70). Progression-free survival was also longer after the addition of chemotherapy (HR, 0.65; 95% CI, 0.52-0.81; P &lt; .001), while the locoregional failure rate was not significantly different (subhazard ratio, 0.62; 95% CI, 0.30-1.26; P = .19). The survival benefit of the chemoradiation group was present in patients up to age 80 years (65-69 years: HR, 0.52; 95% CI, 0.33-0.82; 70-79 years: HR, 0.60; 95% CI, 0.43-0.85), but was absent in patients aged 80 years or older (HR, 0.89; 95% CI, 0.56-1.41).Conclusions and RelevanceIn this cohort study of older adults with LA- HNSCC, chemoradiation, but not cetuximab-based bioradiotherapy, was associated with longer survival compared with radiotherapy alone.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

et al. 2023

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“…Our investigators hypothesize that this hypofractionated regimen will significantly improve treatment tolerance, with no change in disease control efficacy at 6 months. 108 , 109 …”

Section: Treatmentmentioning

confidence: 99%

“…Our investigators hypothesize that this hypofractionated regimen will significantly improve treatment tolerance, with no change in disease control efficacy at 6 months. 108,109 There are conflicting data regarding RT-related toxicity in the elderly population, with studies reporting either increased or similar RT-induced toxicity in elderly patients compared to a younger cohort; 10,19,[110][111][112] however, the association between increased RT toxicity and the addition of chemotherapy in the elderly population is well established. 10,110 A review of Radiation Therapy Oncology Group (RTOG) CRT trials for HNSCC demonstrated significantly higher rates of severe late toxicity (defined as chronic grade 3+ pharyngeal/laryngeal toxicity and/or requirement for a feeding tube ≥2 years after registration and/or potential treatment-related death within 3 years) in the elderly cohort.…”

Section: Dovepressmentioning

confidence: 99%

Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

Dickstein¹,

Powers²,

Vujović³

et al. 2023

CIA

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Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.

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“…There are an estimated 650 000 new cases and 350 000 deaths annually worldwide, representing approximately 6% of all cases 1 . In all tumors that originated from the head and neck, including the mouth, oropharynx, hypopharynx, and larynx, 95% of them are squamous cell carcinoma in histological type 2 . The incidence of HNC varies greatly in different regions of the world.…”

Section: Introductionmentioning

confidence: 99%

SPP1 as a key gene in the lymph node metastasis and a potential predictor of poor prognosis in head and neck carcinoma

Feng

Yuan

Sun

et al. 2022

J Oral Pathology Medicine

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Background: Lymph node metastasis (LNM) is an important cause leading to recurrence and development of head and neck carcinoma (HNC), with the precise mechanisms unclear. Thus, we aimed to identify the key genes involved in LNM and further evaluate their expressions and roles.Methods: A cohort of HNC in the TCGA was analyzed. The study involved three phases (one screening and two validation phases). First, the differentially expressed genes regarding LNM were screened, from which a key gene was identified by a series of data mining approaches. Then, the expressions and roles of the key gene were validated in HNC through bioinformatics. Afterward, the expression of the key gene was detected by qPCR, western blot, and Immunohistochemistry based on a cell model and a tissue microarray. Further, colony formation and transwell migration and invasion assays were used to evaluate the roles of the key gene.Results: SPP1 was overexpressed in HNC tissues and was identified as the key gene.Overexpression of SPP1 in HNC was correlated with advanced pathological stages and T-stage, as well as the presence of LNM, which predicted poor prognosis. The expression of SPP1 was closely associated with the infiltration of immune cells in HNC, especially M2 macrophages. Lab experiments confirmed that SPP1 silence in HNC cells resulted in weakened invasive and metastatic abilities. Conclusion:This study reveals that SPP1 may be a key gene associated with LNM in HNC, raising the possibility of SPP1 as a target for HNC prevention and treatment.

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Management of Older Adults with Locally Advanced Head and Neck Cancer

Cited by 13 publications

References 118 publications

Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer

SPP1 as a key gene in the lymph node metastasis and a potential predictor of poor prognosis in head and neck carcinoma

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