IMRT/VMAT for malignancies in the head-and-neck region : Outcome in patients aged 80.
OBJECTIVE
Elderly patients with malignant head-and-neck tumors (HNT) often pose a therapeutic challenge. They frequently have significant comorbidities which may influence their ability to tolerate tumor-specific therapies. Our aim was to investigate the outcome of patients aged 80+ years undergoing curative intent intensity- or volume-modulated radiation therapy (IMRT/VMAT).


METHODS
We retrospectively reviewed our HNT patients aged 80+ treated with curative IMRT/VMAT from December 2003 to November 2015. Overall survival (OS), disease-free survival (DFS), local control (LC), and treatment tolerance were assessed. Outcome results were compared with that of a younger HNT patient cohort from our hospital.


RESULTS
A total of 140 consecutive patients were included (65 postoperative, 75 definitive). Mean/median age at treatment start was 84.8/84.1 years (range 80-96 years). Mean/median follow-up time was 25/16 months (range 2-92 months). Of the 140 patients, 80 were alive with no evidence of disease when last seen, 28 had died due to the cancer, 12 remained alive with disease, the remaining 20 died intercurrently. Systemic concomitant therapy was administered in 7 %. Late grade 3-4 toxicity was observed in 2 %. All patients completed treatment. Hospitalization and feeding tube rates were 26 % and 11 %, respectively. The 2‑/3-year LC, DFS, and OS rates for the entire cohort were 81/80 %, 69/63 %, and 68/66 %, respectively. Squamous cell carcinoma (SCC) patients showed an inferior 3-year OS rate as compared to non-SCC patients (62 % vs 77 %, p = 0.0002), while LC and DFS did not differ. Patients undergoing postoperative radiation attained a higher OS compared to the definitively irradiated subgroup with 74 vs. 60 % at 3 years (p = 0.01); however, DFS rates were similar for both groups (68 vs. 61 %, p = 0.15). Corresponding rates for >1400 HNT patients <80 years treated during the same time interval were 81/80 %, 69/67 %, and 77/72 %, respectively.


CONCLUSIONS
Treatment tolerance in our patients aged 80+ was high. These results suggest that elderly HNT patients should not be denied potentially curative treatment strategies.
Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Michelle L
ML
Brown
Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Christoph
C
Glanzmann
Department of Otorhinolaryngology, Head Neck Cancer Center, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
Gerhard
G
Huber
Department of Craniomaxillofacial and Oral Surgery, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland.
Marius
M
Bredell
Department of Medical Oncology, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland.
Tamara
T
Rordorf
Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. gabriela.studer@luks.ch.
Gabriela
G
Studer
D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D011832:Radiation Injuries / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
Elderly; Radiation tolerance; Radiotherapy of elderly patients; Survival analysis; Treatment outcome