Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy

Abstract

Objectives Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population. Materials and Methods Retrospective study of LA-HNC patients ≥70 years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3 years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured. Results Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76 years; range, 70–94; male, 61%; ECOG PS, 0–1 43%; stage IVA/B, 71%). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32% with a median follow-up time of 39.2 months. The majority (86.5%) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62%) and developed aspiration during swallowing evaluation post-treatment (44%). Several patients required hospice (9%) or skilled nursing facility (13%) referrals during treatment. Conclusion Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.

Elderly Patients With Squamous Cell Carcinoma of the Head and Neck and the Benefit of Multimodality Therapy

“…Competing causes of death likely represented a smaller overall contribution to adverse outcomes in this group because cancer is the primary cause of death in patients with late-stage head and neck cancer. These findings are consistent with a retrospective review of patients aged .70 years undergoing concomitant chemoradiation for locally advanced head and neck cancer by Maggiore et al [9] They demonstrated a 5-year survival of 32% and found that 86.5% of patients were able to complete all treatment cycles [9]. Although multimodality therapy appears to provide a survival advantage in appropriately selected patients aged .70 years, our results also demonstrate the benefits of unimodality therapy in cases in which more aggressive treatment cannot be tolerated.…”

The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity‐modulated radiotherapy era

“…21 By contrast, our study included only patients aged 70 and older with stage III-IVB oropharyngeal cancer and receiving IMRT with platinum- or cetuximab-based systemic therapy. Another strength of our study is that the vast majority (81 of 85, 95%) diagnosed with locally advanced head and neck cancer at our institution during the time period of this study received concomitant systemic therapy.…”

The Older Adult With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma: Knowledge Gaps and Future Direction in Assessment and Treatment

“…91 Additionally, higher rates of enteral feeding tube use with longer-term follow-up following CRT for LA-HNSCC are observed among adults age ≥70 years. 92,93 There are limited data evaluating and comparing methods of enteral nutritional support [i.e., nasogastric (NG) tube versus percutaneous gastrostomy (PEG) tube placement] in terms of relative safety and efficacy in mitigating more significant weight loss or long-term dysphagia in patients with HNSCC regardless of age. 94–96 A prospective trial evaluating NG vs PEG tube placement in patients undergoing RT/CRT (median age = 60 years) showed less weight loss with PEG placement but higher duration of use/dependence, higher Grade 3 dysphagia at 6 months post-treatment, and higher costs and complication rates.…”