title: Stereotactic body radiotherapy as primary treatment for elderly patients with medically inoperable head and neck cancer.
abstract: OBJECTIVE
  With a growing elderly population, elderly patients with head and neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated co-morbidities, and conventional local therapies, such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients' quality of life (QoL). Stereotactic body radiotherapy (SBRT) is a well-established curative strategy for medical-inoperable early-stage lung cancers even in elderly populations; however, there is limited data examining SBRT as primary therapy in head and neck cancer.
  
  
  METHODS
  Twelve patients with medically inoperable head and neck cancer treated with SBRT ± cetuximab from 2002 to 2013 were retrospectively reviewed. SBRT consisted of primarily 44 Gy in five fractions delivered on alternating days over 1-2 weeks. Concurrent cetuximab was administered at a dose of 400 mg/m(2) on day -7 followed by 250 mg/m(2) on day 0 and +7 in n = 3 (25%). Patient-reported quality of life (PRQoL) was prospectively recorded using the previously validated University of Washington quality of life revised (UW-QoL-R).
  
  
  RESULTS
  Median clinical follow-up was 6 months (range: 0.5-29 months). The 1-year actuarial local progression-free survival, distant progression-free survival, progression-free survival, and overall survival for definitively treated patients were 69, 100, 69, and 64%, respectively. One patient (8%) experienced acute grade 3 dysphagia and one patient (8%) experienced late grade 3 mucositis; there were no grade 4-5 toxicities. Prospective collection of PRQoL as assessed by UW-QoL-R was preserved across domains.
  
  
  CONCLUSIONS
  Stereotactic body radiotherapy shows encouraging survival and relatively low toxicity in elderly patients with unresectable head and neck cancer, which may provide an aggressive potentially curative local therapy while maintaining QoL.
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Vargo
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology, Division of Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Clump
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology, Division of Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
keywords: SBRT; cetuximab; elderly; head and neck cancer; radiosurgery