Preliminary Outcome and Quality of Life among Geriatric Head and Neck Cancer (GHNC) Patients Treated with Institutional Nimorad (Nimotuzumab-Modulated Radiotherapy) Protocol

Abstract

<h3>Purpose/Objective(s)</h3> Treatment for geriatric head and neck squamous carcinomas (GHNC) remain challenging due to multiple patient and treatment related factors. We analyzed radical intent treatment for GHNC with modulated arc therapy (VMAT) and concurrent Nimotuzumab (Nim) as part of prospectively maintained database NIMORAD (Nimotuzumab-modulated radiotherapy) for early clinical outcome and toxicity. <h3>Materials/Methods</h3> 30 (M:25, F:5) patients of biopsy proven locally advanced squamous cell carcinomas staged by whole body PETCT scan (stage III-IVB) were analyzed. All were above 70 years (Range: 70-88 years) and received uniform treatment with VMAT (66-70 Gy/33 fractions) and Inj Nim 200mg weekly for 6 cycles. Cisplatin ineligibility was in terms of age>70, multiple comorbidities, deranged kidney or hearing functions. Patients more than 80 years were selected for NIMORAD only if baseline G8 screening score was 14 or more. All the cases were discussed in Institutional GHNCC (Geriatric head neck cancer clinic). Institutional comprehensive geriatric assessment was followed with G8 scoring, activities of daily living (ADL) by Katz index, nutritional scoring by subjective global assessment (SGA) and co-morbidity scoring with Charlsons comorbidity index (CCI). Primary analysis was related to survival (disease free survival, local control and overall survival) and toxicity. First surveillance PETCT was between 10-14 weeks post treatment. The toxicities were graded as per CTCAE version 3.0. Follow up was every 3 months with 2^nd surveillance PETCT 6-8 months depending on 1^st response. Statistical analyses were carried out using statistical software. <h3>Results</h3> Median follow-up, age and G8 screening score were 18 months, 77 years and 13 respectively. 83.3% patients were male and 60% had oropharyngeal primaries with 10% HPV positive. At 1^st follow up complete response (CR) at primary site was 85% on both FOL and PETCT. Till last follow up 60% had complete response, 16% had loco-regional failure and 2% distant metastases. Nine patients died till last follow up and 5 were lost to follow up. All P16 positive patients (3) had loco-regional and distant control till last follow up. The acute grade 2 mucositis and dysphagia were 70% and 90% respectively with 30% grade 3 dysphagia. Long term tube dependency rates were 10% mostly beyond 80 years. 20% had hematological grade 2 plus toxicity and 10% had skin rash due to Nim. The other notable adverse events were grade 3 trismus, osteoradionecrosis and aspiration pneumonia between 2-5%. Median Katz index was 5, SGA and CCI were higher for hospitalized patients. <h3>Conclusion</h3> This single Institution NIMORAD protocol for GHNC shows promising clinical results with no additional toxicity profile. This can be an option for improved disease control in locally advanced GHNC. Future large cohort prospective documentation with longer follow up is warranted.