Abstract
Simple SummaryLocally advanced head and neck squamous cell carcinomas (HNSCC) are often managed with surgery and postoperative radiochemotherapy (RCT). Until now, a deeper understanding of specific management strategies for elderly patients was lacking. In the present study, we compared patients ≥70 years of age and younger patients treated with postoperative RCT for HNSCC. All patients were treated with modern radiotherapy techniques (IMRT/VMAT). Elderly patients had more comorbidities. In addition, they less frequently received concomitant systemic treatment. The rates of mucositis and dermatitis were lower in patients ≥70 years. Elderly patients had significantly worse overall survival and progression-free survival. Locoregional and distant control were comparable in elderly and younger patients. In conclusion, postoperative radiochemotherapy is a safe and effective treatment option in patients ≥70 years. In light of comorbidities and poor survival rates, potential benefits and harms of radiotherapy and concomitant systemic treatment should be weighed carefully for this age group.Locally advanced head and neck squamous cell carcinomas (HNSCC) are often managed with surgery followed by postoperative radiochemotherapy (RCT). With the general increase in life expectancy, the proportion of elderly patients with HNSCC is expected to grow rapidly. Until now, a deeper understanding of specific management strategies for these patients in clinical routine was lacking. In the present study, we compared elderly patients (≥70 years, n = 52) and younger patients (n = 245) treated with postoperative RCT for HNSCC at our tertiary cancer center. All patients were irradiated with modern radiotherapy techniques (IMRT/VMAT). Patients ≥70 years of age had more comorbidities. Additionally, elderly patients less frequently received concomitant systemic treatment. The rates of mucositis and dermatitis were lower in patients ≥70 years. Elderly patients had significantly worse overall and progression-free survival. Locoregional and distant control were comparable in elderly and younger patients. In conclusion, postoperative RCT is a safe and effective treatment option in patients ≥70 years. In light of comorbidities and poor overall survival rates, benefits and harms of radiotherapy and concomitant systemic treatment should be weighed carefully. When exclusively applying up-to-date radiotherapy techniques with, at the same time, careful use of concomitant systemic therapy, favorable acute toxicity profiles are achieved.
Highlights
Head and neck squamous cell carcinomas (HNSCC) caused 450,000 deaths worldwide in 2018 [1]
We evaluated overall survival (OS; event: patient death due to any cause), progression-free survival (PFS; events: patient death due to any cause and any tumor progression), time to recurrence (TTR; events: local, regional or distant tumor progression, death due to head and neck squamous cell carcinomas (HNSCC)), locoregional control (LRC; events: local or regional tumor progression), and distant control (DC; event: occurrence of distant metastases)
When comparing elderly patients treated with radiotherapy alone vs. elderly patients treated with RCT, we found no differences in toxicities, OS, TTR and LRC, possibly due to the low number of patients
Summary
Head and neck squamous cell carcinomas (HNSCC) caused 450,000 deaths worldwide in 2018 [1]. At the same time, regarding the general increase of life expectancy, the proportion of elderly patients with HNSCC is expected to grow rapidly [1,10]. In the major clinical trials on treatment strategies in HNSCC, these patients were either excluded or were underrepresented [3,4,11]. This is the case for earlier trials which established the indications for postoperative RCT as well as for contemporary prospective trials on treatment strategies in HNSCC [3,4,11,12]. Until now, a deeper understanding of the implications of the findings for clinical routine was lacking [15]
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