Does age matter in achieving optimum chemotherapy delivery in managing head and neck cancer with primary chemo-radiotherapy?

Abstract

Purpose of the study: Older patientswith head and neck cancermay be denied the potentially beneficial addition of chemotherapy to primary radiotherapy in the management of head and neck cancer, because of fears that older patients will develop relatively more treatment related morbidity and not tolerate treatment, when compared to younger patients. This could lead to breaks in, or discontinuation of radiotherapy giving poorer outcomes for survival and local control in older patients. Methods: We have reviewed a cohort of 141 head and neck cancer patients who had definitive primary chemo-radiotherapy over the period 2007–2009 in our department, and examined whether patients 65 years of age and over received as much chemotherapy as those patients below 65 years and why patients in both groups, did not receive the total chemotherapy dose prescribed. Results: Despite the younger patient group having a better performance status and lower ACE 27 (Adult Co-morbidity Evaluation 27) score, both younger and older groups received comparable total doses of chemotherapy. There were similar admission rates during chemo-radiotherapy for treatment-related morbidity, number of inpatient days, number of multiple admissions and incidence of febrile neutropenia, in both older and younger patient groups. Conclusions: Our study suggests that older patients, with head and neck cancer, where the use of chemotherapy is appropriate, can tolerate primary chemo-radiotherapy as well as younger head and neck cancer patients, and that older patients should not be denied chemotherapy on the basis of presumed increased morbidity.