title: Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer.
abstract: OBJECTIVE
  To report outcomes and predictive factors of overall survival, hospitalization and treatment completion rates in elderly patients with locally advanced head and neck cancer treated with concurrent chemoradiotherapy (CRT).
  
  
  METHODS
  A retrospective analysis of patients aged 70years or older treated with concurrent CRT for locally advanced head and neck cancer was conducted. Univariate and multivariate analysis as well as competing risk survival analysis were used to determine predictors of mortality. Logistic regression was used to predict for hospitalization and treatment completion rates.
  
  
  RESULTS
  In total, 129 patients were included. Median follow-up was 27months (range: 1.7-125months). Completion rate of combined CRT was 84%. Actuarial OS and DSS at 4years were 56% and 75%. Hospitalization rate was 36%. On multivariate analysis, a Karnofsky performance status (KPS) ⩽80 was predictive of mortality. Using competing risks, KPS ⩽80 and weight loss >5% were predictive of cancer mortality whereas Charlson score ⩾3 was predictive of mortality due to other causes. On logistic regression, patients with abnormal renal function and lower body mass index were more likely to be hospitalized during their treatment course. Charlson score and chemotherapy regimen were predictive of treatment completion.
  
  
  CONCLUSIONS
  Concurrent CRT may be a feasible treatment option for healthier older patients at the cost of high hospitalization rates. Pre-treatment factors linked to physiological age such as KPS ⩽80, Charlson score ⩾3, abnormal renal function should be considered at the time of treatment decision.
authors: Department of radiation oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada. Electronic address: houda.bahig@umontreal.ca.
authors: Houda
authors: H
authors: Bahig
authors: Department of radiation oncology, Hopital Maisonneuve Rosemont, Montreal, QC, Canada.
authors: Bernard
authors: B
authors: Fortin
authors: Department of radiation oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Moein
authors: M
authors: Alizadeh
authors: Department of radiation oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Louise
authors: L
authors: Lambert
authors: Department of radiation oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Edith
authors: E
authors: Filion
authors: Department Otolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Louis
authors: L
authors: Guertin
authors: Department Otolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Tareck
authors: T
authors: Ayad
authors: Department Otolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Apostolos
authors: A
authors: Christopoulos
authors: Department Otolaryngology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Eric
authors: E
authors: Bissada
authors: Department of Hemato-oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Denis
authors: D
authors: Soulières
authors: Department of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Francine
authors: F
authors: Gaba Idiamey
authors: Department of radiation oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors: Phuc Felix
authors: PF
authors: Nguyen-Tan
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
keywords: Aged; Chemoradiotherapy; Chemotherapy; Geriatrics; Head and neck cancer; Hospitalization; Radiotherapy; Survival; Tolerance; Toxicity