Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort
Abstract
Background: The objective of this study was to assess the treatment outcomes and prognostic factors of elderly patients with locally advanced head and neck cancer (LAHNC) undergoing radiotherapy (RT).
Materials and methods: A retrospective cohort from a single institution, from 2000 to 2015, including patients older than 65 years old with LAHNC (stage III–IVa) treated by RT combined or not with chemotherapy (CRT). Univariate and multivariate analysis (MVA) were performed to identify prognostic factors associated with overall survival (OS), cancer-specific survival (CSS), and locoregional control (LRC). A p-value < 0.05 was considered significant.
Results: 220 patients with LAHNC and > 65 years of age were identified. The median follow-up was 3.8 years, the 3/5 years estimated OS, CSS, and LRC rate was 40%/30%, 49%/34%, 76%/45%, respectively. In the univariate analysis, clinical stage (III vs. IVa/b, p = 0.01), tumor stage (T1/2 vs. T3/4, p = 0.035), Karnofsky performance status (KPS, 60–70, p = 0.03) and tumor site (other than vs. hypopharynx, p = 0.0001) were associated with lower OS. Patients with clinical stage (III vs. IVa/b, p = 0.01), tumor stage (T1/2 vs. T3/4, p = 0.015), N stage (N0/1 vs. N2/3, p = 0.04), (KPS 60-70, p = 0.04) and tumor site (other than vs. hypopharynx, p = 0.0001) had worst CSS. For the LRC, clinical stage (III vs. IVa/b, p = 0.02), tumor stage (T1/2 vs. T3/4, p = 0.02), treatment type (CRT vs. RT, p = 0.02), RT technique (IMRT vs. 2DRT/3DRT, p = 0.0001), and tumor site (other than vs. hypopharynx, p = 0.02) were significant. In the MVA, KPS maintained significant for OS and CSS. For LRC, clinical stage (Iva/b, p = 0.007), tumor stage (T3/4, p = 0.047) and radiotherapy technique other than IMRT (p = 0.0001) were significant.
Conclusion: The OS, CSS, and LRC were associated with several prognostic factors. The clinical performance was the main marker of OS and CSS. Chemoradiation should be offered to selected elderly patients using IMRT to improve LRC.
Keywords: head and neck cancerelderlyradiotherapyoutcomes
References
- Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
- Vokes EE, Weichselbaum RR, Lippman SM, et al. Head and neck cancer. N Engl J Med. 1993; 328(3): 184–194.
- Porceddu SV, Scotté F, Aapro M, et al. Treating Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck Unsuitable to Receive Cisplatin-Based Therapy. Front Oncol. 2019; 9: 1522.
- Pezzuto F, Buonaguro L, Caponigro F, et al. Update on Head and Neck Cancer: Current Knowledge on Epidemiology, Risk Factors, Molecular Features and Novel Therapies. Oncology. 2015; 89(3): 125–136.
- Pignon JP, le Maître A, Maillard E, et al. MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009; 92(1): 4–14.
- Gugić J, Strojan P. Squamous cell carcinoma of the head and neck in the elderly. Rep Pract Oncol Radiother. 2012; 18(1): 16–25.
- Haehl E, Rühle A, David H, et al. Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly? Radiat Oncol. 2020; 15(1): 31.
- VanderWalde NA, Fleming M, Weiss J, et al. Treatment of older patients with head and neck cancer: a review. Oncologist. 2013; 18(5): 568–578.
- Derks W, de Leeuw JRJ, Hordijk GJ, et al. Reasons for non-standard treatment in elderly patients with advanced head and neck cancer. Eur Arch Otorhinolaryngol. 2005; 262(1): 21–26.
- Steer CB, Brain EGC. Geriatric oncology and supportive care: A global approach to advance the science. J Geriatr Oncol. 2016; 7(5): 313–314.
- Bernardi D, Barzan L, Franchin G, et al. Treatment of head and neck cancer in elderly patients: state of the art and guidelines. Crit Rev Oncol Hematol. 2005; 53(1): 71–80.
- Santos FM, Viani GA, Pavoni JF. Evaluation of survival of patients with locally advanced head and neck cancer treated in a single center. Braz J Otorhinolaryngol. 2019 [Epub ahead of print].
- Leeman JE, Li JG, Pei X, et al. Patterns of Treatment Failure and Postrecurrence Outcomes Among Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma After Chemoradiotherapy Using Modern Radiation Techniques. JAMA Oncol. 2017; 3(11): 1487–1494.
- Lusinchi A, Bourhis J, Wibault P, et al. Radiation therapy for head and neck cancers in the elderly. Int J Radiat Oncol Biol Phys. 1990; 18(4): 819–823.
- Amini A, Jones BL, McDermott JD, et al. Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base. Cancer. 2016; 122(10): 1533–1543.
- Zapata I, Alvarez M, Hidalgo R, et al. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer. 2019; 19(1): 1241.
- Kwon M, Roh JL, Song J, et al. Noncancer health events as a leading cause of competing mortality in advanced head and neck cancer. Ann Oncol. 2014; 25(6): 1208–1214.
- Takenaka Y, Yasui T, Enomoto K, et al. Risk factors associated with competing mortality among patients with head and neck cancer in Japan. Acta Otolaryngol. 2016; 136(3): 325–329.
- Nguyen NP, Vock J, Chi A, et al. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol. 2012; 188(8): 677–683.