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Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?

BACKGROUND: Head-and-neck squamous cell carcinoma (HNSCC) is one of the most common malignancies globally, and the number of elderly patients diagnosed with HNSCC is increasing. However, as elderly HNSCC patients are underrepresented in clinical trials, current clinical decision making for this coho...

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Autores principales: Haehl, Erik, Rühle, Alexander, David, Hélène, Kalckreuth, Tobias, Sprave, Tanja, Stoian, Raluca, Becker, Christoph, Knopf, Andreas, Grosu, Anca-Ligia, Nicolay, Nils H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001207/
https://www.ncbi.nlm.nih.gov/pubmed/32019576
http://dx.doi.org/10.1186/s13014-020-1481-z
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author Haehl, Erik
Rühle, Alexander
David, Hélène
Kalckreuth, Tobias
Sprave, Tanja
Stoian, Raluca
Becker, Christoph
Knopf, Andreas
Grosu, Anca-Ligia
Nicolay, Nils H.
author_facet Haehl, Erik
Rühle, Alexander
David, Hélène
Kalckreuth, Tobias
Sprave, Tanja
Stoian, Raluca
Becker, Christoph
Knopf, Andreas
Grosu, Anca-Ligia
Nicolay, Nils H.
author_sort Haehl, Erik
collection PubMed
description BACKGROUND: Head-and-neck squamous cell carcinoma (HNSCC) is one of the most common malignancies globally, and the number of elderly patients diagnosed with HNSCC is increasing. However, as elderly HNSCC patients are underrepresented in clinical trials, current clinical decision making for this cohort largely lacks clinical evidence. METHODS: Elderly patients (≥65 years) with HNSCC undergoing (chemo)radiotherapy from 2010 to 2018 at Freiburg University Medical Center were assessed for patterns of care, locoregional control (LRC), progression-free (PFS) and overall survival (OS) regarding definitive and adjuvant treatments. Acute and late therapy-associated toxicities were quantified according to CTCAE v5.0. RESULTS: Two hundred forty-six patients were included in this analysis, of whom 166 received definitive and 80 adjuvant treatment. Two-year rates for OS, PFS and LRC were 56.9, 44.9 and 75.5%, respectively. Survival differed significantly between age groups with an OS of 40 and 22 months and a PFS of 23 and 12 months for patients aged 65–74 or ≥ 75 years, respectively (p < 0.05). Concomitant chemotherapy resulted in improved OS in patients aged 65–74 years compared to radiotherapy alone (p < 0.05) for definitive treatments, while patients ≥75 years did not benefit (p = 0.904). For adjuvant chemoradiotherapy, a trend towards superior OS rates was observed for patients aged 65–74 years (p = 0.151). Low performance status (HR = 2.584, 95% CI 1.561–4.274; p < 0.001) and smoking (HR = 1.960, 95% CI 1.109–3.464, p < 0.05) were the strongest independent prognostic factor in the multivariate analysis for decreased OS. One hundred thirty-eight patients (56.1%) experienced acute grade 3/4 and 45 patients (19.9%) chronic grade 3 toxicities. CONCLUSION: Radiotherapy is a feasible treatment modality for elderly HNSCC patients. The relatively low OS compared to high LRC may reflect age and comorbidities. Concomitant chemotherapy should be critically discussed in elderly HNSCC patients.
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spelling pubmed-70012072020-02-10 Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly? Haehl, Erik Rühle, Alexander David, Hélène Kalckreuth, Tobias Sprave, Tanja Stoian, Raluca Becker, Christoph Knopf, Andreas Grosu, Anca-Ligia Nicolay, Nils H. Radiat Oncol Research BACKGROUND: Head-and-neck squamous cell carcinoma (HNSCC) is one of the most common malignancies globally, and the number of elderly patients diagnosed with HNSCC is increasing. However, as elderly HNSCC patients are underrepresented in clinical trials, current clinical decision making for this cohort largely lacks clinical evidence. METHODS: Elderly patients (≥65 years) with HNSCC undergoing (chemo)radiotherapy from 2010 to 2018 at Freiburg University Medical Center were assessed for patterns of care, locoregional control (LRC), progression-free (PFS) and overall survival (OS) regarding definitive and adjuvant treatments. Acute and late therapy-associated toxicities were quantified according to CTCAE v5.0. RESULTS: Two hundred forty-six patients were included in this analysis, of whom 166 received definitive and 80 adjuvant treatment. Two-year rates for OS, PFS and LRC were 56.9, 44.9 and 75.5%, respectively. Survival differed significantly between age groups with an OS of 40 and 22 months and a PFS of 23 and 12 months for patients aged 65–74 or ≥ 75 years, respectively (p < 0.05). Concomitant chemotherapy resulted in improved OS in patients aged 65–74 years compared to radiotherapy alone (p < 0.05) for definitive treatments, while patients ≥75 years did not benefit (p = 0.904). For adjuvant chemoradiotherapy, a trend towards superior OS rates was observed for patients aged 65–74 years (p = 0.151). Low performance status (HR = 2.584, 95% CI 1.561–4.274; p < 0.001) and smoking (HR = 1.960, 95% CI 1.109–3.464, p < 0.05) were the strongest independent prognostic factor in the multivariate analysis for decreased OS. One hundred thirty-eight patients (56.1%) experienced acute grade 3/4 and 45 patients (19.9%) chronic grade 3 toxicities. CONCLUSION: Radiotherapy is a feasible treatment modality for elderly HNSCC patients. The relatively low OS compared to high LRC may reflect age and comorbidities. Concomitant chemotherapy should be critically discussed in elderly HNSCC patients. BioMed Central 2020-02-04 /pmc/articles/PMC7001207/ /pubmed/32019576 http://dx.doi.org/10.1186/s13014-020-1481-z Text en © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Haehl, Erik
Rühle, Alexander
David, Hélène
Kalckreuth, Tobias
Sprave, Tanja
Stoian, Raluca
Becker, Christoph
Knopf, Andreas
Grosu, Anca-Ligia
Nicolay, Nils H.
Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title_full Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title_fullStr Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title_full_unstemmed Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title_short Radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
title_sort radiotherapy for geriatric head-and-neck cancer patients: what is the value of standard treatment in the elderly?
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001207/
https://www.ncbi.nlm.nih.gov/pubmed/32019576
http://dx.doi.org/10.1186/s13014-020-1481-z
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