Primary concurrent chemoradiation therapy with triweekly cisplatin as a standard protocol in patients aged ≥65 years with head and neck squamous cell carcinoma.

Abstract

To evaluate the results of primary concurrent chemoradiation therapy (CCRT) with triweekly cisplatin in patients with head and neck squamous cell carcinoma (HNSCC) aged ≥65 years by comparing these patients to those aged<65 years. This prospective, single-center study enrolled patients with HNSCC for whom CCRT was indicated as the primary treatment. The major endpoints were progression-free survival (PFS) and overall survival (OS). A total of 169 patients were enrolled; 75 (44.4%) and 94 (55.6%) patients were aged ≥65 and<65 years, respectively. The mean cumulative cisplatin doses were 192.8mg/m2 and 212.3mg/m2 in patients ≥65 and<65, respectively (p<.001). The incidence rates of any grade 3-4 toxicities were 37.3% and 51.1% in the age ≥65 and<65 groups, respectively (p=.085). The 5-year locoregional control, distant control, PFS, ultimate PFS, and disease-specific survival were comparable between both groups. The 5-year OS was significantly lower in the ≥65 group than the<65 group (65.5%vs. 86.4%, p=.010) due to a lower salvage rate and higher incidence of non-HNSCC-related death. In a Cox regression analysis, age ≥65 years was not associated with increased risk of treatment failure but was associated with higher overall death rate (hazard ratio, 2.590; 95% confidence interval, 1.219-5.502; p=.013). CCRT with a triweekly cisplatin regimen could act as the standard of ca for HNSCC in elderly patients. However, the relatively lower OS compared to younger patients should be acknowledged, despite a favorable disease control rates.