Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

Bonomo, Pierluigi; Desideri, Isacco; Loi, Mauro; Russo, Monica Lo; Olmetto, Emanuela; Maragna, V.; Francolini, Giulio; Paoli, Camilla Delli; Grassi, Roberta; Pezzulla, D.; Greto, Daniela; Meattini, Icro; Livi, Lorenzo

doi:10.1016/j.oraloncology.2017.10.004

Cited by 27 publications

(20 citation statements)

References 39 publications

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“…Based on the existence of differences in pharmacokinetics and treatment tolerance, most clinical trials in oncology consider the age of 70 as the reference to define a patient as elderly. In studies conducted on patients with HNSCC, patients with ages above 60, 65, 70, 75, or 80 years old have been considered as elderly patients, and others have defined different categories within patients over 65 years old 2‐4,7‐11,20‐24 . The rationale to establish a certain cutoff is different across the studies: definition of advanced age established by the national health system, retirement age, or age limit for the inclusion of patients in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Does age influence disease‐specific survival in patients with squamous cell carcinomas of the head and neck?

Lop

Valero

Garcı́a

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The number of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) at an advanced age has increased. The aim of this study is to evaluate the age at which disease-specific survival (DSS) significantly decreases in HNSCC. Methods:We performed a retrospective study of 5469 patients with HNSCC treated at our center . External validation with 2082 oral squamous cell carcinomas from a collaborative institution from another continent was performed. Results:We observed an orderly decrease in overall survival as age at diagnosis increased. There were no differences in DSS based on age for patients <80 years old (P = .623), while older patients had a significant decrease in DSS. These results were validated in the independent dataset. In a multivariable analysis performed in the test set, compared to patients <80 years old, patients between 80 to 85 had a 1.50 times higher risk of disease-specific death (95% confidence interval [CI]: 1.19-1.89; P = .001), and patients >85 had a 2.19 times higher risk (95% CI: 1.68-2.87; P < .001).Conclusions: DSS started to significantly decrease in HNSCC at 80 years old. These findings, validated in an independent cohort, indicate that chronological age on its own should not withhold curative treatment in the majority of patients with HNSCC.

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Section: Discussionmentioning

confidence: 99%

Does age influence disease‐specific survival in patients with squamous cell carcinomas of the head and neck?

Lop

Valero

Garcı́a

et al. 2020

Journal of Surgical Oncology

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“…In HNSCC, the G8 appears to be the diagnostic screening tool with a greater ability to select vulnerable patients, who should need a full CGA . In our review, only 2 studies use some kind of geriatric, QoL, or functional assessments among the RT trials, 2 studies of the trial on systemic therapy, 4 in surgical studies, and 17 in papers on results of multimodal treatment . Most of them did not use a specific geriatric tool.…”

Section: The Selection Of Patients For Therapymentioning

confidence: 98%

“…Specific RT techniques and protocols, such as intensity modulated radiotherapy (IMRT), intensity modulated radiotherapy/image guided radiotherapy simultaneous integrated boost (IMRT/IGRT SIB), and hypofractionation, seem to be feasible and well‐tolerated in elderly. Based on the published literature, age itself seems not to be a limiting factor in curative radical RT, even in the octogenarian and nonagenarians .…”

Section: Adverse Events and Survival After Different Treatment Modalimentioning

confidence: 99%

“…According to our search criteria, 2543 papers were initially identified. After sorting and removal of duplicates, 82 papers that fully fit our inclusion criteria were retrieved, reviewed in detail, and summarized in Tables according to the modality of treatment used: RT, systemic therapy (CT or targeted therapy), surgery, or multimodal therapy …”

Section: Introductionmentioning

confidence: 99%

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The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

et al. 2019

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Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age-related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

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“…Although elderly patients have historically been excluded from trials due to practical and ethical considerations, including unique medical demands as well as concerns regarding dosing and adverse events, the current consensus is that the elderly should be enrolled with protective measures in place (eg, more frequent follow‐up) 43,44 . Additionally, this cohort in particular may benefit from the use of emerging and re‐emerging low toxicity therapeutic strategies including brachytherapy 45 and de‐intensified hypofractionation 46 . These treatment strategies have already been found to minimize toxicity and improve tolerability which will be especially useful for this patient population.…”

Section: Discussionmentioning

confidence: 99%

Treatment tolerability and outcomes in elderly patients with head and neck cancer

et al. 2020

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Purpose The number of elderly patients with head and neck squamous cell carcinoma (HNSCC) continues to grow. Management of this cohort remains poorly defined. We investigated treatment tolerability and clinical outcomes in this underrepresented population. Methods We identified patients aged ≥70 with nonrecurrent, nonmetastatic HNSCC treated curatively from 2007‐2018 and analyzed clinical covariates. Results Two hundred and twenty patients with a median age of 75 (interquartile range:72‐80) were identified. Age and comorbidities were not correlated with toxicity (P ≥ .05). Patients who experienced a treatment interruption had significantly greater weight loss (P = .042) and worse overall survival (OS) (P < .001), but not worse disease‐specific survival (P = .45), or locoregional control (P = .21). Conclusions Treatment interruptions were associated with weight loss and worse OS, but not disease related outcomes, suggesting an interruption in the elderly may be a surrogate for another issue. In sum, our data should guide clinical trial design to benefit this growing, neglected cohort.

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Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

Cited by 27 publications

References 39 publications

Does age influence disease‐specific survival in patients with squamous cell carcinomas of the head and neck?

Does age influence disease‐specific survival in patients with squamous cell carcinomas of the head and neck?

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Treatment tolerability and outcomes in elderly patients with head and neck cancer

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