Treatment modalities, adverse events, and survival outcomes in older patients with head and neck squamous cell carcinoma

Amr, Sania; Ioffe, Dina; Suzuki, Ikumi; Mehra, Ranee; Cullen, Kevin J.; Goloubeva, Olga

doi:10.1002/hed.26893

Cited by 5 publications

(5 citation statements)

References 32 publications

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“…However, this is consistent with our data from OPSCC, suggesting that overall performance status is more important than the physical age of the patient. Also, this is consistent with the suggestion that not only chronological but also biological age and functional status (and probably other factors) should be considered when selecting the best cancer treatment [ 45 , 46 , 47 ].…”

Section: Discussionsupporting

confidence: 88%

Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region

Wagner

Langer

Wuerdemann

et al. 2023

Cancers

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Background: Human papillomavirus (HPV) status is the most important predictor of survival in oropharyngeal squamous cell carcinoma (OPSCC). In patients with cervical lymph node metastases of squamous cell carcinoma of unknown origin (CUPHNSCC), much less is known. Methods: We assessed a consecutive cohort of CUPHNSCC diagnosed from 2000–2018 for HPV DNA, mRNA, p16INK4a (p16) expression, and risk factors to identify prognostic classification markers. Results: In 32/103 (31%) CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%). This was mostly consistent with mRNA detection. In recursive partitioning analysis, CUPHNSCC patients were classified into three risk groups according to performance status (ECOG) and p16. Principal component analysis suggests a negative correlation of p16, HPV DNA, and gender in relation to ECOG, as well as a correlation between N stage, extranodal extension, and tobacco/alcohol consumption. Conclusions: Despite obvious differences, CUPHNSCC shares similarities in risk profile with OPSCC. However, the detection of p16 alone appears to be more suitable for the classification of CUPHNSCC than for OPSCC and, in combination with ECOG, allows stratification into three risk groups. In the future, additional factors besides p16 and ECOG may become important in larger studies or cases with special risk profiles.

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Section: Discussionsupporting

confidence: 88%

Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region

Wagner

Langer

Wuerdemann

et al. 2023

Cancers

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“…The authors concluded that patient characteristics other than age should be considered equally in selecting the best therapy for elderly patients. 19…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, multimodal treatment and surgical treatment were associated with improved OS, and radiation therapy alone was associated with worse functional outcomes in multivariate analysis for the entire cohort and the oldest cohort (≥80 years). The authors concluded that patient characteristics other than age should be considered equally in selecting the best therapy for elderly patients 19 …”

Section: Discussionmentioning

confidence: 99%

“…The authors concluded that patient characteristics other than age should be considered equally in selecting the best therapy for elderly patients. 19 In a recent systematic review of 116 studies, ASA (60.3%) and CCI (33.6%) were the most commonly used comorbidity indices to evaluate outcomes in patients with head and neck surgery. 20 When evaluating studies that utilized the CCI, the authors found that it reliably predicted 1-year mortality.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative and 1‐Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older

Davis

Kompelli

Gardner

et al. 2022

Otolaryngol.--head neck surg.

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Objective To evaluate the postoperative and 1-year functional outcomes after free flap surgery among patients ≥80 years old. Study Design Retrospective chart review. Setting Single tertiary care center. Methods We conducted a retrospective review of 596 patients who underwent head and neck ablation and reconstruction with free tissue over a 7-year period. Patients ≥80 years of age were included. Results Fifty patients were ≥80 years old, with an average age of 83.7 years. Ninety-day mortality was 12.0%, and those who died were of older age (87.5 vs 83.1 years, P = .036). Prior radiation therapy (odds ratio, 6.8 [95% CI, 1.1-42.7]) and a Charlson Comorbidity Index ≥3 (odds ratio, 10.0 [95% CI, 1.5-67.0]) were associated with an increased risk of 90-day mortality. Overall 21 (42.0%) patients experienced a 30-day complication; 7 (14.0%) were readmitted within 30 days; and 5 (10.0%) underwent additional flap-related operations. Flap failure occurred in 2 (4.0%) patients. Before surgery, 45 (90%) patients were living independently or within assisted living; among these, 19.5% declined to dependent functional status at 90-day follow-up. At 90 days, 2 (8.3%) of 24 patients remained tracheostomy dependent, and 20 (66.7%) of 30 patients required feeding tube supplementation. Among 42 patients, 36 (85.7%) had unrestricted or modified oral diets at 90 days. Charlson Comorbidity Index ≥2 was associated with an increased risk of 1-year mortality (odds ratio, 5.1 [95% CI, 1.4-18.6]). Conclusion The potential for functional decline and risk of 90-day mortality should be discussed with patients aged ≥80 years.

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“…Within this broad age spectrum, variations in treatment outcomes may exist among different age subgroups. Several cohort studies have indicated that elderly patients can safely undergo definitive chemoradiotherapy and derive benefits from it [4]. However, for subgroups exceeding the age range of 78-80 in developed countries, the acceptability of such treatments may be diminished.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome of elderly patients (≥ 78 years) with head and neck squamous cell carcinoma: A single center experience

Liu,

Wang,

Deng

et al. 2024

Biomol Biomed

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Patients older than the expected age of the local population generally have limited life expectancy. The optimal treatment approach for very elderly patients with head and neck cancer remains uncertain. This study retrospectively analyzed patients over 78 years old, the expected age in 2019 for Chinese individuals, who underwent treatment for head and neck cancer at a tertiary cancer center in China. The study compared the overall survival rates among different treatment groups. The findings revealed that among patients eligible for surgery, radical resection yielded better outcomes compared to radiotherapy-based treatments, with a hazard ratio of 0.362 (95% CI 0.160-0.819, P=0.015). Among patients who received radiotherapy, those who received a total dose exceeding 60 Gy had a significantly longer survival compared to those who received palliative doses, with median survival time of 31 months versus 14 months (P=0.003). Among 78 patients who underwent conventional fractionated radiotherapy (CFRT), 15 patients (19.23%) experienced unscheduled treatment breaks with a median duration of 12 days. However, these treatment breaks did not appear to impact survival (P>0.1). The study also suggested that altered fractionated radiotherapy, including hypofractionated radiotherapy (hypo-RT), could be a viable alternative to CFRT, offering similar survival outcomes with reduced treatment duration. In conclusion, eligible patients should be treated with curative intent, even if they are older than the expected age of the local population. When radiotherapy is indicated, altered fractionation, particularly hypo-RT, may be a favorable option to consider.

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Treatment modalities, adverse events, and survival outcomes in older patients with head and neck squamous cell carcinoma

Cited by 5 publications

References 32 publications

Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region

Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region

Postoperative and 1‐Year Functional Outcomes After Free Flap Surgery Among Patients 80 Years or Older

Treatment outcome of elderly patients (≥ 78 years) with head and neck squamous cell carcinoma: A single center experience

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