Safety and efficacy of concurrent chemoradiotherapy for head-and-neck cancers in older versus younger patients: Post hoc analysis of a randomized controlled trial

Abstract

Background: Head-and- neck squamous cell carcinoma (HNSCC) is a commonly occurring malignancy in the geriatric population. However, there is a scarcity of data regarding the efficacy and safety of concurrent chemoradiotherapy (CRT) in these patients.Objectives: We performed a post hoc analysis of a randomized study conducted at our institution to compare the outcomes and toxicities of concurrent CRT in older versus younger patients with HNSCC.Materials and Methods: The present analysis is based on a study conducted at Tata Memorial Hospital, Mumbai, India, on patients with locally advanced HNSCC, planned for radical concurrent CRT. The patients were randomized to receive cisplatin either once-a-week at a dose of 30 mg/m2 or once-in-3-weeks at a dose of 100 mg/m2. The database of this study was used for the post hoc analysis. We evaluated the differences in the demographic and clinical features, grade 3 or worse adverse events, compliance to treatment, locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) between the older (aged ≥ 60 years) and the younger patients.Results: Out of 300 patients, 283 (94.3%) comprised the younger cohort (age <60 years) and 17 (5.7%) comprised the older cohort. There was no difference in the occurrence of severe (grade 3/4) toxicities between the two groups. At a median follow-up of 22 months (range, 3–51 months), the cumulative LRC at 2 years was 67.1% and 100% for the younger and older groups, respectively (P = 0.018). The estimated median PFS in younger patients was 24.4 months (95% confidence interval, 12.5–36.3), while it was not reached in the older group (P = 0.53). The estimated median OS was 41.3 months in the younger patients but was not reached in the older group (P = 0.613).Conclusions: Cisplatin-based concurrent CRT appears to be as efficacious in carefully selected fit older patients as in younger patients; moreover, toxicities appear to be similar in both the groups.