Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?

Haehl, Erik; Rühle, Alexander; David, Hélène; Kalckreuth, Tobias; Sprave, Tanja; Stoian, Raluca; Becker, Christoph; Knopf, Andreas; Grosu, Anca‐Ligia; Nicolay, Nils H.

doi:10.1186/s13014-020-1481-z

Cited by 57 publications

(75 citation statements)

References 43 publications

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“…Additionally, retrospective analyses of treatment-related toxicities especially of chronic adverse reactions are complicated, as follow-up consultations were not performed by all patients especially during end-of-life phases, leading to underrepresentation of treatment-related toxicities. Especially chronic toxicities such as chondronecrosis or soft tissue fibrosis were not routinely assessed in our cohort and may be underrepresented, as other series reported significantly higher rates of these chronic normal tissue reactions after re-irradiation [46][47][48]. Although the median OS of 25 months was relatively satisfying in our study, the median PFS of 9 months underlines the importance of additional treatment modalities in order to improve both locoregional control and distant metastasis-free survival.…”

Section: Discussionmentioning

confidence: 76%

The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

et al. 2020

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Background: Treatment for local and locoregional recurrence or second head-and-neck (H&N) cancers after previous radiotherapy is challenging, and re-irradiation carries a significantly increased risk for radiotherapy-related normal tissue toxicities and treatment failure due to a radioresistant tumor phenotype. Here, we analyzed reirradiation management and outcomes in patients with recurrent or second primary H&N carcinoma using state-ofthe-art diagnostic procedures and radiotherapy techniques. Methods: Between 2010 and 2019, 48 patients with recurrent or second primary H&N carcinoma received reradiotherapy at the University of Freiburg Medical Center and were included in this study. Overall survival (OS) and progression-free survival (PFS) were calculated with the Kaplan-Meier method, and univariate Cox-regression analyses were performed to assess the effects of clinico-pathological factors on treatment outcomes. Acute and chronic treatment-related toxicities were quantified using the Common Terminology Criteria for Adverse Events (CTCAE v4.03). Results: Thirty-one patients (64.6%) received definitive and 17 (35.4%) adjuvant radiotherapy. Simultaneous chemotherapy was administered in 28 patients (58.3%) with cetuximab as the most commonly used systemic agent (n = 17, 60.7%). After a median time of 17 months (range 4 months to 176 months) between first and second radiotherapy, patients were re-irradiated with a median of 58.4 Gy and a treatment completion rate of 87.5% (n = 42). Median OS was 25 months with a 1-year OS amounting to 62.4%, and median PFS was 9 months with a 1-year PFS of 37.6%. Univariate analyses demonstrated that both a lower rT-status and a radiotherapy boost were associated with improved OS (p < 0.05). There was a trend towards superior OS for patients who received > 50 Gy (p = 0.091) and who completed the prescribed radiotherapy (p = 0.055). Five patients (10.4%) suffered from at least one grade 3 toxicities, while 9 patients (27.3%) experienced chronic higher-grade toxicities (≥ grade 3) with one (3.0%) grade 4 carotid blowout and one (3.0%) grade 4 osteoradionecrosis.

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Section: Discussionmentioning

confidence: 76%

The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

et al. 2020

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“…The two-year overall survival (OS), progression-free survival (PFS) and local/locoregional control (LRC) of our elderly HNSCC cohort ranged at 56.9%, 44.9% and 75.5%, respectively ( Figure S2 ) [ 18 ]. Baseline anemia, defined as a hemoglobin level below 12 g/dL, resulted in significantly impaired PFS ( p < 0.01, log-rank test) and OS (HR = 1.536, 95% CI 1.058–2.231, p < 0.05), while LRC was not influenced ( p = 0.332) ( Figure 2 A–C, Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…One hundred and forty-seven patients (59.8%) received concomitant systemic treatment, mostly with platinum-based regimens. Detailed patient and treatment characteristics were described previously and can be found in Table 1 and Table S1 [18]. Fisher's exact tests were carried out to reveal potential differences between the radiotherapy and chemoradiotherapy group.…”

Section: Patient Characteristicsmentioning

confidence: 99%

The Value of Laboratory Parameters for Anemia, Renal Function, Systemic Inflammation and Nutritional Status as Predictors for Outcome in Elderly Patients with Head-and-Neck Cancers

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David

et al. 2020

Cancers

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The purpose of this study was to evaluate the value of routine blood markers regarding their predictive potential for treatment outcomes of elderly head-and-neck squamous cell carcinoma (HNSCC) patients. In total, 246 elderly HNSCC patients (≥65 years) undergoing (chemo)radiotherapy from 2010 to 2018 were analyzed for treatment outcomes, depending on their hemoglobin, glomerular filtration rate (GFR), C-reactive protein (CRP) and albumin values, representing anemia, kidney function, inflammation and nutrition status, respectively. Local/locoregional control, progression-free and overall survival (OS) were calculated using the Kaplan–Meier method. Cox analyses were performed to examine the influence of blood parameters on oncological outcomes. In the univariate Cox regression analysis, hemoglobin ≤ 12 g/dL (HR = 1.536, p < 0.05), a GFR ≤ 60 mL/min/1.73 m2 (HR = 1.537, p < 0.05), a CRP concentration > 5 mg/L (HR = 1.991, p < 0.001) and albumin levels ≤ 4.2 g/dL (HR = 2.916, p < 0.001) were significant risk factors for OS. In the multivariate analysis including clinical risk factors, only performance status (HR = 2.460, p < 0.05) and baseline albumin (HR = 2.305, p < 0.05) remained significant prognosticators. Additionally, baseline anemia correlated with the prevalence of higher-grade chronic toxicities. We could show for the first time that laboratory parameters for anemia (and at least partly, tumor oxygenation), decreased renal function, inflammation and reduced nutrition status are associated with impaired survival in elderly HNSCC patients undergoing (chemo)radiotherapy.

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“…As a patient's chronologic age alone provides insufficient information regarding the optimal treatment decision, geriatric assessments have proven their value in predicting treatment tolerance and compliance [6]. Whereas more and more studies have demonstrated both the feasibility and the effectiveness regarding radiotherapy for elderly patients, radiotherapy for patients aged ≥90 years is poorly studied in the literature [7][8][9][10]. Although there is a limited number of retrospective studies analyzing the treatment outcomes of radiotherapy for nonagenarian patients, evidence regarding radiotherapy for this patient group remains poor due to relatively low patient numbers in most of these studies [11][12][13][14][15][16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy for nonagenarians: the value of biological versus chronological age

et al. 2020

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Background: The number of nonagenarian cancer patients (≥ 90 years) is continuously increasing, and radiotherapy is performed in a relevant proportion of patients, as surgery and chemotherapy are often not feasible for these patients. However, the evidence regarding the feasibility and treatment outcomes after radiotherapy for this patient group is very limited. Methods: All nonagenarian patients receiving (chemo) radiotherapy between 2009 and 2019 at the University of Freiburg-Medical Center were analyzed for patterns of care, overall survival (OS) and therapy-associated toxicities according to the Common Terminology Criteria for Adverse Events. Uni-and multivariate Cox regression analyses were conducted to assess the influence of patient-and treatment-related factors on patient outcomes. Results: One hundred nineteen patients with a total of 137 irradiated lesions were included in this analysis. After a median follow-up of 27 months, median OS was 10 months with a 3-year OS amounting to 11.1%. Univariate analyses demonstrated that a reduced performance status (HR = 1.56, 95% CI 1.00-2.45, p < 0.05), a higher burden of comorbidities (HR = 2.00, 95% CI 1.00-4.10, p < 0.05) and higher UICC tumor stages (HR = 2.21, 95% CI 1.14-4.26, p < 0.05) were associated with impaired survival rates. Split-course treatments (HR = 2.05, 95% CI 1.07-3.94, p < 0.05), non-completion of radiotherapy (HR = 7.17, 95% CI 3.88-13.26, p < 0.001) and palliative treatments (HR = 2.84, 95% CI 1.68-4.81, p < 0.05) were found to result in significantly reduced OS. In the multivariate analysis, split-course concepts (HR = 2.21, 95% CI 1.10-4.37, p < 0.05) and palliative treatments (HR = 3.19, 95% CI 1.77-5.75, p < 0.001) significantly deteriorated outcomes, while impaired ECOG status (HR = 1.49, 95% CI 0.91-2.43, p = 0.11) did not. The vast majority of patients reported either no (n = 40; 33.6%) or grade 1-2 acute toxicities (n = 66; 55.5%), and only very few higher-grade toxicities were observed in our study. Conclusion: Radiotherapy for nonagenarian patients is generally feasible and associated with a low toxicity profile. Given the relatively poor OS rates and the importance of the quality of life for this patient group, individualized treatment regimens including hypofractionation concepts should be considered.

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Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?

Cited by 57 publications

References 43 publications

The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

The value of moderate dose escalation for re-irradiation of recurrent or second primary head-and-neck cancer

The Value of Laboratory Parameters for Anemia, Renal Function, Systemic Inflammation and Nutritional Status as Predictors for Outcome in Elderly Patients with Head-and-Neck Cancers

Radiotherapy for nonagenarians: the value of biological versus chronological age

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