Feasibility and early results of accelerated radiotherapy for head and neck carcinoma in the elderly

Abstract

BACKGROUND. Accelerated radiotherapy (RT) represents a promising method with which to improve the treatment outcome in patients with head and neck carcinoma. However, its applicability to elderly patients has not been well established. This study assessed treatment toxicities, patient compliance, and oncologic results in patients age Ն 70 years who were treated with an accelerated concomitant boost RT schedule. METHODS. Between 1991 and 1997, 39 patients aged Ն 70 years (mean, 75 Ϯ 6 years) presenting with carcinomas of the oral cavity, pharynx, or larynx were treated radically with a modified concomitant boost RT schedule (planned dose of 69.9 grays [Gy] over 38 days). Based on American Joint Committee on Cancer staging, there were 14 patients with Stage I-II disease and 25 patients with Stage III-IV disease. Eighty-one patients age Ͻ 70 years who were treated with the same RT schedule served as a comparative group. The median follow-up for the surviving patients was 19 months (range, 3-65 months) and 23 months (range, 2-76 months), respectively, for the elderly and younger patient groups.

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

“…Incidence of grade III and higher mucositis in our study was 43.7%. Allal et al [13] in their study in elderly patients treated with hyperfractionated radiotherapy reported a grade 3-4 mucositis incidence of 66%. It is possible that use of IMRT with its better sparing of normal structures led to better compliance and tolerance in our group of patients.…”

“…Late toxicity (grade III or above) was observed in only 3% patients. Similar result had been reported by Allal et al [13] We observed a complete response (CR) rate of 77.4%, matching previous reports by Zachariah et al [15]. Locoregional control at 2 years was 71.6% and overall survival at 2 years was 89.9%.…”

Longitudinal oncology registry of head and neck carcinoma (LORHAN®): initial supportive care findings

“…Surgical mortality rises with increasing age [10]; however, this is thought to be secondary to the increased rates of co-morbidities. Indeed, the available surgical [11][12][13] and radiation therapy literature demonstrate that appropriately selected elderly HNC patients tolerate therapy as well as their younger counterparts [14][15][16]. Whether elderly patients benefit from aggressive chemoradiation regimens is a separate question.…”

Radiation therapy in the elderly: More side effects and complications?

“…Altered fractionation has gained popularity and is considered standard radiotherapy treatment in head and neck cancer patients that are not candidates for radio-chemotherapy. Allal et al [21] reported in a retrospective study of patients treated with accelerated fractionation that treatment interruptions were more common in older patients, but no differences were seen in acute toxicities based on age. In summary, the available data with radiation alone fail to support a correlation between age and toxicity in head and neck patients, but older patients may suffer a more important functional impact and therefore be more vulnerable to the secondary effects of the treatment [22].…”