Abstract
PurposeOlder patients with head and neck cancer (HNC) represent a challenging group, as frailty and comorbidities need to be considered. This study aimed to evaluate the efficacy and side effects of curative and palliative (chemo) radiation ([C]RT) with regard to basic geriatric screening in older patients.MethodsThis study included HNC patients aged ≥70 years who were treated with curative or palliative (C)RT. Clinicopathological data including Charlson Comorbidity Index (CCI), Karnofsky performance status (KPS), and treatment data were analyzed as predictors of overall survival (OS).ResultsA total of 271 patients (median age, 74 years) were enrolled. The majority had UICC stage III/IV (90%) and underwent curative treatment (85.2%). A total of 144 (53.1%) patients received definitive and 87 (32.1%) had adjuvant (C)RT. Overall, 40 patients (14.8%) received palliative (C)RT. Median follow-up duration (curative setting) was 87 months, and the 2- and 5-year OS rates were 57.8 and 35.9%, respectively. Median OS was significantly different for age ≤75 vs. >75 years, CCI <6 vs. ≥6, KPS ≥70 vs. <70%, Tx/T1/T2 vs. T3/T4, and adjuvant vs. definitive (C)RT, respectively. Age 70–75 years (p = 0.004), fewer comorbidities when CCI < 6 (p = 0.014), good KPS ≥ 70% (p = 0.001), and adjuvant (C)RT (p = 0.008) independently predicted longer survival. Palliative RT resulted in a median OS of 4 months.ConclusionOlder age, lower KPS, higher CCI, and definitive (C)RT are indicators of worse survival in older patients with HNC treated curatively. Without a comprehensive geriatric assessment in patients aged >75 years, the KPS and CCI can be useful tools to account for “fitness, vulnerability or frailty” to help in treatment decision-making.
Highlights
In developed countries, older generations are becoming the dominant demographic groups, and the number of oncological patients is increasing
This study assessed the Overall survival (OS) of older patients with head and neck cancer (HNC) treated with curative and palliative (C)radiotherapy alone (RT) with respect to comorbidities and performance scores in baseline assessments
In a Japanese study, the risk of non-cancer-related death increased with an HR of 2.59 in patients aged 76 years and older, without a significant increase in HNC-related deaths [13]
Summary
Older generations are becoming the dominant demographic groups, and the number of oncological patients is increasing. The number of deaths among cancer patients aged 80 years and older is almost twice as often as from heart disease than from cancer [1]. Curative treatment of locally advanced (LA) HNC with surgery and/or chemoradiation (CRT) is commonly associated with severe treatment-related toxicity, and recent findings suggest that older patients >70 years with locally advanced head and neck squamous cell carcinoma (HNSCC) have an increased 90-day mortality after concurrent CRT [3]. In daily oncological practice in many countries, a comprehensive geriatric assessment (CGA) is seldom part of the decision-making process in a multidisciplinary approach for older patients with HNC. The selection of older patients fit for an intensive multimodal treatment or moderately suitable for less intensive curative radiotherapy alone (RT), and frail older patients appropriate for palliative RT or best supportive care needs careful evaluation to achieve the greatest benefit for the individual patient
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