Treatment Outcomes and the Safety of Chemoradiotherapy With High-Dose CDDP for Elderly Patients With Head and Neck Squamous Cell Carcinoma: A Propensity Score Matching Study.

Jo Omata,Kohei Saijo,Keisuke Yamazaki,Arata Horii,Yuichiro Sato,Hisayuki Ota,Ryusuke Shodo,Takeshi Takahashi,Yushi Ueki,Takafumi Togashi

doi:10.3389/fsurg.2021.753049

Jo Omata, Kohei Saijo + Show 8 more

Open Access

https://doi.org/10.3389/fsurg.2021.753049

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Abstract

Objective: We aimed to compare the outcomes and safety of chemoradiotherapy (CRT) between elderly and non-elderly patients with head and neck squamous cell carcinoma (HNSCC). It is difficult to assess the causal effect of age because of possible differences in general conditions among individuals. Therefore, we adjusted the background factors of elderly and non-elderly patients using propensity score matching (PSM).Methods: A total of 146 patients with HNSCC who received CRT were divided into an elderly (≥70 years, n = 35) and non-elderly group (<70 years, n = 111). Pre-treatment characteristics, including the performance status, Charlson comorbidity index, body mass index, primary site, and TNM stage were adjusted by PSM. We compared the outcomes and safety of CRT with high-dose single-agent cisplatin (CDDP) as well as outcomes following recurrence between the groups, before and after PSM.Results: The total dose of CDDP administered during CRT was significantly lower in the elderly group before PSM. However, it became comparable to the non-elderly group and adverse events did not differ between the groups following PSM, resulting in a comparable CRT completion rate. Overall-, disease specific-, and progression-free survivals of elderly patients were comparable to those of non-elderly patients following PSM. In contrast, elderly patients with recurrence could receive fewer salvage treatments than their non-elderly counterparts, resulting in worse survival.Conclusions: CRT with high-dose CDDP is safe and effective for the treatment of elderly patients with HNSCC. However, salvage treatments can be rarely conducted for elderly patients with a recurrence, considering a deterioration of their general condition.

Highlights

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy, with 890,000 new cases and 450,000 deaths per year globally [1, 2]
We evaluated the following patient characteristics as background factors: age, sex, Eastern Cooperative Oncology Group performance status (PS), comorbid disease, Charlson comorbidity index (CCI),19 body mass index (BMI) at baseline, primary tumor site, and TNM stage according to the Unio Internationalis Contra Cancrum 8th classification
Before propensity score matching (PSM), the elderly group received a significantly lower total dose of CDDP (p = 0.045). They demonstrated a longer duration of hospitalization following treatment (p < 0.001) and more grade three events or higher hyponatremia (p = 0.038)

Summary

Introduction

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy, with 890,000 new cases and 450,000 deaths per year globally [1, 2]. Considering the worldwide increase in life expectancy over the past few decades, the number of elderly patients with HNSCC has increased further. Over 25% of patients with HNSCC are older than 70 years [3, 4]. Aging involves the loss of function of multiple organs and systems. Elderly patients cannot tolerate treatment stress [5]. Safety management in the treatment of elderly patients with HNSCC is a clinical issue

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