Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer

Bahig, Houda; Fortin, B.; Alizadeh, M.; Lambert, Louise; Filion, Édith; Guertin, Louis; Ayad, Tareck; Christopoulos, Apostolos; Bissada, Éric; Soulières, Denis; Idiamey, Francine Gaba; Nguyen-Tân, Phuc Félix

doi:10.1016/j.oraloncology.2015.02.097

Cited by 33 publications

(24 citation statements)

References 31 publications

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“…15 This was corroborated in our study as demonstrated by a hospitalization rate during or within 6 weeks of radiotherapy completion of 36%. 15 This was corroborated in our study as demonstrated by a hospitalization rate during or within 6 weeks of radiotherapy completion of 36%.…”

Section: Discussionsupporting

confidence: 88%

“…14 Other retrospective studies have demonstrated that measures of comorbidity such as the Charlson comorbidity index 15 and a comorbidity polypharmacy score 16 can predict OS in elderly patients with mHNSCC. This supports assertions from other retrospective studies that have suggested that treatment decisions should be based on performance status and comorbidities, and that patients should not be denied aggressive treatment based on chronologic age alone.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

et al. 2019

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Background: Elderly patients with mucosal squamous cell carcinomas of the head and neck (mHNSCC) represent a challenging clinical dilemma. Methods: A retrospective review was performed of patients ≥75 years, treated with curative-intent radiotherapy for mHNSCC in two quaternary Sydney hospitals between 2007 and 2017. Results: Ninety-five patients met inclusion criteria. The median age was 79 years (75-94). Patients received radiotherapy alone (n = 24), concurrent chemoradiotherapy (n = 22), surgery and adjuvant radiotherapy (n = 45), or surgery with adjuvant chemoradiotherapy (n = 4). Median follow-up was 4.5 years, median overall survival (OS) was 3.8 years, and 2-year and 5-year OS were 56% and 43%, respectively. Eastern Cooperative Oncology Group performance status of ≥2 (P < .001) was a statistically significant predictor of reduced OS. Thirty-four patients (36%) required hospitalization, 5 (5%) did not complete radiotherapy, and 9 (9%) were feeding tube dependent beyond 6 months. Conclusions: Appropriately selected elderly patients can achieve durable outcomes from curative intent radiotherapy with acceptable treatment toxicity. K E Y W O R D Selderly, geriatric oncology, head and neck cancer, performance status, radiotherapy

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

et al. 2019

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“…This is consistent with several other retrospective series suggesting that concurrent chemoradiation may be feasible in patients older than 70 years old. 10,19,26–28 . Second, we think that administering cetuximab to the geriatric population deemed unfit for platinum-based chemotherapy, although common, is not supported by current evidence and does not represent an efficacious, well tolerated, or cost-effective approach.…”

Section: Discussionmentioning

confidence: 99%

“…In what to our knowledge is one of the largest geriatric chemoradiation studies published to date, a KPS 80, Charlson Comorbidity Index 3, and weekly platinum were associated with lower rates of treatment completion for patients undergoing chemoradiation. 20 An abnormal glomerular filtration rate and lower body mass index were found to be associated with high rates of hospitalization. 20 In our study, we were not able to test a KPS 80 and Charlson Comorbidity Index 3 as toxicity predictors because we had very few patients in these categories.…”

Section: Discussionmentioning

confidence: 99%

“…20 An abnormal glomerular filtration rate and lower body mass index were found to be associated with high rates of hospitalization. 20 In our study, we were not able to test a KPS 80 and Charlson Comorbidity Index 3 as toxicity predictors because we had very few patients in these categories. Significant work remains to develop clinically validated tools for treatment selection in the geriatric population with head and neck cancer.…”

Section: Discussionmentioning

confidence: 99%

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

Zumsteg

Lok

et al. 2016

Cancer

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Background Despite controversy surrounding its benefit, the use of concomitant chemoradiation (CCRT) in oropharyngeal cancer (OPC) patients >70 years old is increasing. However, few studies compare outcomes of different systemic treatments in this population. Methods Records from 74 patients with stage III-IVB OPC ≥70 years old undergoing CCRT from 2002 to 2013 at a single institution were reviewed. Patients were stratified according to systemic therapy received, including cisplatin (CDDP), carboplatin with either 5-FU or paclitaxel (CARB), or cetuximab to compare oncologic outcome and toxicity. Results Median follow-up was 36 months. The median age was 75.3 years (range 70–91), with significantly older patients receiving cetuximab (P=0.03). Twenty-eight, 20, and 26 patients received CCRT with CDDP, CARB, and cetuximab, respectively. Radiation interruptions longer than 1 day were needed in 4% (CDDP), 20% (CARB), and 15% (cetuximab, P=0.19). Unplanned hospitalizations during CCRT occurred in 25%, 55%, and 58% of patients receiving CDDP, CARB, and cetuximab, respectively (P=0.03). There were two treatment-related deaths, both in patients treated with cetuximab. At 5 years, locoregional control was achieved in 100%, 88%, and 60% (P<0.001) and overall survival was 87%, 61%, and 47% (P=0.03) with CDDP, CARB, and cetuximab, respectively. Conclusion Toxicity from CCRT remains a challenge for older adults with OPC. We found no evidence this was mitigated by cetuximab. Nevertheless, a subset of patients aged 70 and older appear to tolerate CDDP-based treatment with acceptable toxicity and excellent outcomes. Further identification of this subgroup is crucial to optimize therapy for older OPC patients.

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Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

et al. 2023

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ImportanceThe number of older adults with head and neck squamous cell carcinoma (HNSCC) is increasing, and these patients are underrepresented in clinical trials. It is unclear whether the addition of chemotherapy or cetuximab to radiotherapy is associated with improved survival in older adults with HNSCC.ObjectiveTo examine whether the addition of chemotherapy or cetuximab to definitive radiotherapy is associated with improved survival in patients with locoregionally advanced (LA) HNSCC.Design, Setting, and ParticipantsThe Special Care Patterns for Elderly HNSCC Patients Undergoing Radiotherapy (SENIOR) study is an international, multicenter cohort study including older adults (≥65 years) with LA-HNSCCs of the oral cavity, oropharynx/hypopharynx, or larynx treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between January 2005 and December 2019 at 12 academic centers in the US and Europe. Data analysis was conducted from June 4 to August 10, 2022.InterventionsAll patients underwent definitive radiotherapy alone or with concomitant systemic treatment.Main Outcomes and MeasuresThe primary outcome was overall survival. Secondary outcomes included progression-free survival and locoregional failure rate.ResultsAmong the 1044 patients (734 men [70.3%]; median [IQR] age, 73 [69-78] years) included in this study, 234 patients (22.4%) were treated with radiotherapy alone and 810 patients (77.6%) received concomitant systemic treatment with chemotherapy (677 [64.8%]) or cetuximab (133 [12.7%]). Using inverse probability weighting to attribute for selection bias, chemoradiation was associated with longer overall survival than radiotherapy alone (hazard ratio [HR], 0.61; 95% CI, 0.48-0.77; P &lt; .001), whereas cetuximab-based bioradiotherapy was not (HR, 0.94; 95% CI, 0.70-1.27; P = .70). Progression-free survival was also longer after the addition of chemotherapy (HR, 0.65; 95% CI, 0.52-0.81; P &lt; .001), while the locoregional failure rate was not significantly different (subhazard ratio, 0.62; 95% CI, 0.30-1.26; P = .19). The survival benefit of the chemoradiation group was present in patients up to age 80 years (65-69 years: HR, 0.52; 95% CI, 0.33-0.82; 70-79 years: HR, 0.60; 95% CI, 0.43-0.85), but was absent in patients aged 80 years or older (HR, 0.89; 95% CI, 0.56-1.41).Conclusions and RelevanceIn this cohort study of older adults with LA- HNSCC, chemoradiation, but not cetuximab-based bioradiotherapy, was associated with longer survival compared with radiotherapy alone.

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Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer

Cited by 33 publications

References 31 publications

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck

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

Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

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