Postoperative Adjuvant Chemoradiotherapy in Older Patients With Head and Neck Cancer

Abstract

Background: In head and neck cancer, the locoregional failure of patients with positive margins, vascular or perineural invasion, and extracapsular spread is high and results in poor survival. Objective: To assess the effect of adjuvant chemoradiotherapy in improving treatment outcomes among older patients with head and neck cancer. Methods: Forty patients undergoing radical surgery (median age, 73.5 years [range, 70-78 years]) were enrolled (35 men and 5 women; Eastern Cooperative Oncology Group performance status, grade 0-2). Disease sites included the oral cavity (10 patients), oropharynx (12 patients), hypopharynx (8 patients), and larynx (10 patients); pathological TNM classifications included T1 N2 (8 patients), T2 N1-2 (12 patients), T3 N0-2 (8 patients), and T4 N0-2 (12 patients), with the following poor prognostic factors: positive margins (6 patients), vascular invasion (14 patients), neural invasion (16 patients), and extracapsular spread (26 patients). All patients were treated with carboplatin (30 mg/m 2 on days 1-5 of weeks 1, 3, and 5) concomitant with radiotherapy (54.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes; 5 daily fractions of 1.8 Gy each per week). Results: No grade 4 toxicity was observed. Grade 3 toxicity included mucositis (10 patients), neutropenia (6 patients), dermatitis (2 patients), and thrombocytopenia (1 patient). The radiotherapy dose administered was 52.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes. Thirty-two patients (80%) received 3 cycles, 6 (15%) received 2 cycles, and 2 (5%) received 1 cycle. Three-year survival was as follows: disease-free survival, 58%; overall survival, 64%; and local control, 79%. Conclusions: Adjuvant chemoradiotherapy may be successful in fit older patients. The results of adjuvant chemoradiotherapy were better than those observed in a comparable group treated with radiotherapy alone and were similar to those observed in a younger group with the same poor prognostic factors treated with adjuvant carboplatin plus radiotherapy.

Chemoradiation in elderly patients with head and neck cancers: a single institution experience

“…None of our patients developed severe hematologic toxicity. Airoldi et al [14] in their study reported 15% severe hematologic toxicity (grade III or higher), possibly owing to the use of concurrent carboplatin with its greater myelosuppressive effects. In contrast, only 40.6% of our patients received concurrent carboplatin on a weekly schedule.…”

Clinical outcomes of retrograde intra-arterial chemotherapy concurrent with radiotherapy for elderly oral squamous cell carcinoma patients aged over 80 years old

“…Airoldi et al [15] reported the treatment outcome of performing surgery with postoperative CRT for elderly HNM patients (median age, 73.5 years [range, 70–78 years]). According to their report, the 3-year OS and Local control were 64% and 79%, respectively.…”

Mortality in tongue cancer patients treated by curative surgery: a retrospective cohort study from CGRD

“…Recent reports on the relationship between elderly patients with head and neck cancer and their prognosis have been conflicting (Airoldi et al, 2004; Bhattacharyya, 2003; Chang et al, 2013; Clayman et al, 1998; Italiano et al, 2008; Kruse et al, 2010; Luciani et al, 2010; Lusinchi et al, 1990; Ortholan et al, 2009; Sarini et al, 2001; Zabrodsky et al, 2004). Some concluded that older patients suffered a worse survival than younger patients (Bhattacharyya, 2003; Chang et al, 2013; Clayman et al, 1998).…”

“…Some concluded that older patients suffered a worse survival than younger patients (Bhattacharyya, 2003; Chang et al, 2013; Clayman et al, 1998). However, many others failed to show a significant difference between outcomes of old and young patients (Airoldi et al, 2004; Argiris et al, 2004; Lusinchi et al, 1990; Sarini et al, 2001). In many previously published reports (Airoldi et al, 2004; Bhattacharyya, 2003; Chang et al, 2013; Clayman et al, 1998; Italiano et al, 2008; Kruse et al, 2010; Lusinchi et al, 1990; Ortholan et al, 2009; Sarini et al, 2001; Zabrodsky et al, 2004), the cutoff age values (65, 70, 75, 80, or 85 years) and the definition of elderly patients were inconsistent.…”