1002P - Head and neck cancer in the elderly: Is there any reason to change their management?

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Geriatric Oncology
Head and Neck Cancers
Presenter Lara Iglesias
Citation Annals of Oncology (2014) 25 (suppl_4): iv340-iv356. 10.1093/annonc/mdu340
Authors L. Iglesias1, B. Castelo Fernández2, R. Álvarez3, A. Ballesteros4, I. Ghanem2, J.A. Nuñez Sobrino1, A. San Juan Del Moral3, J. Rogado4, A. Diaz1, A. Redondo5, S. Garcia-Adrian6
  • 1Servicio De Oncologia Medica, University Hospital 12 de Octubre Medical oncology, 28041 - Madrid/ES
  • 2Medical Oncology, Hospital Universitario La Paz, Madrid/ES
  • 3Oncology, Hospital Virgen de la Salud, Toledo/ES
  • 4Medical Oncology, Hospital Universitario La Princesa, Madrid/ES
  • 5Medical Oncology, Hospital Universitario la Paz, Madrid/ES
  • 6Medical Oncology, Hospital General de Mostoles, 28935 - Mostoles/ES

Abstract

Aim

There is an increasing number of older patients diagnosed of locally advanced head and neck cancer (LA-HNC) due to the growing life expectancy. The aim of this study is to assess the suitability of bio-chemoradiation therapy (BCRT) for these patients.

Methods

This multicenter retrospective study was performed in four Spanish hospitals. LA-HNC patients ≥ 70 years (ys) treated between January 2009 and December 2011 were included. Demographics, comorbidity, treatment strategies and mortality were recorded.

Results

Sixty-one patients were included (median age, 74.1 ys; range, 70-88; male, 74%; ECOG PS 0-1, 86.4%; stage IVA/IVB, 72%; recurrent disease, 11.5%). Forty-eight percent of subjects had ≥ 2 comorbidities (hypertension 51%; diabetes 21%; myocardial ischemia 15%; bronchopathy 33%, chronic renal insufficiency 25%, hepatopathy 5%). Primary tumor site was: oral cavity 34%; larynx 30%; oropharynx 23%; others 13%. Most of the aged (71%) were treated with radical concomitant BCRT (16% of them had received induction chemotherapy); 28% underwent surgery with adjuvant CRT. The schedules of BCRT were Cetuximab 38 (62.3%), triweekly Cisplatin 15 (24.6%) and others 8 (13.1%). The majority was able to complete all planned treatment (84% radiotherapy; 72% BCT). Complete and partial responses rates were 54% and 18% respectively. Number of comorbidities did not influence the election of BCRT. Nevertheless, ECOG PS ≥ 2 and age > 80 ys were related with cetuximab preference. There were 30 deaths: 21 from neoplasia, 1 from treatment complications (pneumonia). At 27 months' follow-up, 18 relapses and 6 second neoplasms were observed; 49% of the patients were alive (median overall survival 42 m).

ACUTE TOXICITIES N %
HEMATOLOGIC ≥ 3 6 9.8
MUCOSITIS ≥ 3 19 31.1
RASH ≥ 3 5 8.2
INFECTIONS 9 14.8
RENAL FAILURE 7 11.5
ADMISSION TO HOSPITAL 16 26.2

Conclusions

Elderly patients with LA-HNC benefit from radical multidisciplinary treatment. We still have to improve the rate of treatment compliance and reduce the toxicities, including a better election of BCRT schedule, taking into account comorbidities, PS and special needs (social, nutritional …) of this group of patients.

Disclosure

All authors have declared no conflicts of interest.