Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base

Amini, Arya; Jones, Bernard L.; McDermott, Jessica D.; Serracino, Hilary S.; Jimeno, Antonio; Raben, David; Ghosh, Debashis; Bowles, Daniel W.; Karam, Sana D.

doi:10.1002/cncr.29956

Cited by 95 publications

(96 citation statements)

References 37 publications

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“…Given the radical changes in the epidemiology of HNSCC in developed countries, the shift in causative risk factors, and improvements in RT delivery, it is possible that the therapeutic ratio for treatment intensification in older adults with HNSCC is somewhat more favorable in the modern era. 53,54 …”

Section: Methodsmentioning

confidence: 99%

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

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Older adults with squamous cell carcinomas of the head and neck (HNSCC) pose unique treatment and supportive care challenges to oncologists and other cancer care providers. The majority of patients with HNSCC present with locoregionally advanced (LA) disease, for which combined modality treatment integrating chemotherapy and radiation therapy is often necessary to maximize tumor control. However, applying these approaches to an older population with concomitant comorbidities and higher risk for functional impairments remains challenging, and is exacerbated by the paucity of studies involving older adults. The purpose of this paper is to identify knowledge gaps in the evaluation and management of older adults with HNSCC and their caregivers, particularly those undergoing concurrent chemoradiation, through a review of the literature conducted by clinicians, researchers, and patient advocates. The findings highlight the importance of a geriatric assessment and the therapeutic paradigms and challenges relevant to this population. Furthermore, we identify the need for additional research and interventions related to key supportive care issues that arise during and after treatment in older adults with LA-HNSCC. Based on our findings, we prioritized these issues to guide future patient-oriented research endeavors to address these knowledge gaps and thus better serve this growing patient population.

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Section: Methodsmentioning

confidence: 99%

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

Maggiore

Zumsteg

BrintzenhofeSzoc

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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“…A large meta-analysis of chemotherapy in nonmetastatic head and neck cancer found that concurrent chemotherapy with radiation therapy (CRT) significantly improved survival among all comers, but a subset analysis did not find a statistically significant benefit to chemotherapy for patients aged >70 years (7). Contrary to these findings, a recently published cohort study using the National Cancer Data Base (NCDB) revealed that elderly patients might still benefit from concurrent chemotherapy when treated with radiation therapy (RT) in the definitive setting (8). A propensity score—matched analysis, controlling for patient and tumor characteristics, demonstrated a 5-year absolute survival difference of 15% in favor of CRT compared with RT alone among patients aged >70 years.…”

Section: Introductionmentioning

confidence: 95%

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

Pollom

Chin

Lee

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To characterize the patterns of care and potential barriers to access to care for elderly patients with oral cavity cancer in the adjuvant setting. Methods and Materials: We performed a retrospective cohort study using the National Cancer Data Base and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for ≥3 months after surgery. We used logistic regression models to assess the association between age (<70, 70–79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those aged ≥70 years. Results: A total of 25,829 patients were included in the study. Compared with those aged <70 years, older patients were more likely to have no neck dissection or have fewer lymph nodes dissected and were less likely to receive adjuvant therapy than younger patients. Among our cohort, 11,361 patients (44%) had pathologic T3-T4 disease or N2-N3 disease, and 4185 patients (16%) had extracapsular nodal extension or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation therapy in the subgroup with T3 or T4 disease or N2 or N3 disease and adjuvant chemoradiation therapy in the positive extracapsular nodal extension or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation therapy (odds ratio 0.66; 95% confidence interval, 0.55–0.81) and chemoradiation therapy (odds ratio 0.56; 95% confidence interval, 0.40–0.79). Conclusions: In a national hospital-based cohort of patients with oral cavity cancer, elderly patients were less likely to receive adjuvant radiation or chemoradiation therapy. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation therapy and adjuvant chemoradiation therapy.

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“…Se analizó el beneficio de la quimioterapia para cada localización en la supervivencia global, observándose en el grupo de tumores de hipofaringe que la supervivencia a los 5 años era un 3,9 % mejor en aquellos pacientes que habían recibido quimioterapia concomitante. 20 Se han publicado estudios no aleatorizados, algunos específicos en cánceres de la laringe, otros de la hipofaringe [21][22][23][24] y otros mezclando cánceres de laringe e hipofaringe 25,26 . Beauvillain et al 21 compararon los resultados del tratamiento conservador frente a la cirugía radical en tumores resecables de hipofaringe; establecieron dos grupos, el primero tratado con quimioterapia de inducción seguida de cirugía radical con radioterapia postoperatoria y el segundo tratado con quimioterapia de inducción seguida de radioterapia.…”

Section: Discussionunclassified

“…Por lo que no debemos extrapolar los resultados de Hoffman et al 26 al cáncer de hipofaringe, sin embargo, nos recuerda que la QRT ofrece resultados oncológicos similares a la LT pero no superiores.…”

Section: Discussionunclassified

Resultados de la laringectomía total en carcinomas localmente avanzados de hipofaringe

García-Cabo

Fernández-Vañes

López

et al. 2017

Acta Otorrinolaringológica Española

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RESUMENIntroducción y objetivos: La laringectomía total (LT), más eventual radioterapia (RT), ha demostrado ser un tratamiento eficaz en los casos de cáncer de hipofaringe localmente avanzado. El objetivo de este trabajo es analizar los resultados oncológicos de este procedimiento en pacientes con cáncer de hipofaringe T3 y T4.Métodos: Se incluyeron 59 pacientes (33 pacientes con estadio T3 y 26 con estadio T4) con carcinoma epidermoide primario de hipofaringe tratados mediante LT entre los años 1998 y 2012. Los datos analizados fueron sexo, edad, enfermedades debilitantes, antecedente personal y familiar de cáncer, consumo de tabaco y alcohol, el tratamiento cervical ganglionar, la profilaxis antibiótica prequirúrgica, la infección postoperatoria, la presencia de bordes libres en la pieza quirúrgica, el tratamiento radioterápico complementario, el grado histológico, la categoría T-/N-, el estadio de AJCC, el control loco-regional, las metástasis a distancia, la presencia de segundos primarios y la supervivencia global de estos pacientes,.Resultados: La edad media fue de 61 años, con predominio de varones (96,6%). Todos los pacientes excepto uno eran fumadores y el 96% consumía alcohol. Se realizó vaciamiento cervical funcional unilateral en 12 pacientes, radical unilateral en 11 pacientes, funcional bilateral en 20 pacientes y funcional más radical en 14. El 66% de los pacientes recibieron RT postoperatoria. Un 81% de los pacientes presentaba metástasis ganglionares y de estos un 56% presentaba invasión extracapsular. En 54 casos se obtuvieron bordes libres de tumor.Un 28,8% de los pacientes presentaron recidiva locorregional, un 10% desarrollaron metástasis a distancia y un 25,4% desarrollaron un segundo tumor primario. La supervivencia la global observada fue del 30,5%.Conclusiones: El carcinoma escamoso de hipofaringe está asociado a un mal pronóstico, presentándose en estados localmente avanzados con mayor frecuencia. La LT sigue siendo un tratamiento eficaz para el manejo de los pacientes con cáncer de hipofaringe localmente avanzado en la era de la órgano preservación, de modo que los protocolos de preservación de órgano deben alcanzar resultados oncológicos similares a los demostrados por la LT.

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Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base

Cited by 95 publications

References 37 publications

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

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

Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients

Resultados de la laringectomía total en carcinomas localmente avanzados de hipofaringe

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