Outcomes of definitive local therapy with intensity‐modulated radiation therapy in elderly patients ≥70 years with HPV‐associated oropharyngeal cancer

Abstract

The incidence of human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) is increasing among elderly (≥70 years) patients and the optimal treatment approach is not known. In this study, we aimed to determine disease and toxicity outcomes in an elderly HPV‐OPSCC population primarily treated with a chemoradiation (CRT) approach. We identified 70 elderly HPV‐OPSCC patients who were treated with either surgery, radiotherapy, or CRT between 2011 and 2021. Time‐to‐event analysis for overall survival (OS), progression‐free survival (PFS), and local control (LC) were conducted using the Kaplan–Meier method. Univariate and multivariable cox regression models were used to estimate the hazard ratio associated with covariates. The median follow‐up for our cohort was 43.9 months. Of the 70 elderly patients, 55 (78.6%) receive CRT and 15 (22.4%) received RT alone. Two patients underwent TORS resection. Of the 55 patients treated with CRT, the most common systemic agents were weekly carboplatin/taxol (n = 18), cetuximab (n = 17), and weekly cisplatin (n = 11). The 5‐year OS, PFS, and LC were 57%, 52%, and 91%, respectively. On univariate analysis, Eastern Cooperative Oncology Group performance status and Charlson Comorbidity Index (CCI) were significant predictors of OS, while on multivariate analysis only CCI was a significant predictor of OS (p = 0.006). The rate of late peg tube dependency, osteoradionecrosis, and aspiration was 10%, 4%, and 4%, respectively. Definitive local therapy in elderly HPV‐OPSCC patients is associated with excellent LC and a low rate of late toxicities. Prospective studies are needed to further stratify subgroups of elderly patients who may benefit from aggressive definitive local therapy.