Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy.
OBJECTIVE
Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population.


METHODS
Retrospective study of LA-HNC patients ≥ 70 years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3 years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured.


RESULTS
Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76 years; range, 70-94; male, 61%; ECOG PS, 0-1 43%; stage IVA/B, 71%). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32% with a median follow-up time of 39.2 months. The majority (86.5%) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62%) and developed aspiration during swallowing evaluation post-treatment (44%). Several patients required hospice (9%) or skilled nursing facility (13%) referrals during treatment.


CONCLUSIONS
Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.
University of Chicago, Department of Medicine, Section of Hematology/Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA. Electronic address: Ronald.maggiore@uchospitals.edu.
Ronald J
RJ
Maggiore
University of Chicago, Department of Medicine, Section of Hematology/Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Emily K
EK
Curran
University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Mary Ellyn
ME
Witt
University of Chicago, Department of Radiation and Cellular Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Daniel J
DJ
Haraf
University of Chicago, Department of Medicine, Section of Hematology/Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Everett E
EE
Vokes
University of Chicago, Department of Medicine, Section of Hematology/Oncology, Chicago, IL, USA; University of Chicago Comprehensive Cancer Center, Chicago, IL, USA.
Ezra E W
EE
Cohen
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003679:Deglutition / Q000502:physiology; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D005774:Gastrostomy; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000628:therapy*; D007822:Laryngeal Neoplasms / Q000628:therapy*; D008297:Male; D009062:Mouth Neoplasms / Q000628:therapy*; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil
Aspiration; Chemoradiation; Combined modality; Elderly; Gastrostomy tube; Geriatric; Head/neck cancer; Outcomes; Survival