Survival benefit of adding chemotherapy to radiotherapy (RT) in patients (pts) age>70 yrs of head and neck squamous cell carcinoma (HNSCC) has not been found in literature. Our institutional policy is to offer concurrent chemoradiation (CCRT) to patients > 70 years with a good ECOG status.
Retrospective analysis of stage III/IV HNSCC in pts > 70 years who received linac based radical CCRT with dose equivalent to 70Gy in conventional fractionation (n = 57) between 2006 to 2014 were included.
Pts with stage III/IV (25.6%/75.4%) HNSCC (n = 57) of oropharynx (n = 15), larynx (n = 18) or hypopharynx (n = 24) underwent radical CCRT having mean age 75.18 yrs (range 70-86 years) and male to female ratio of 10.4:1. Pts on CCRT who got cisplatin (CIS) (n = 35) and carboplatin(CARBO) (n = 22) had mean weight loss of 3.53 (range 0-10) kgs. 61.4% completed chemotherapy (defined as cumulative dose of 200mg/m2 of CIS and 5 weekly dose of CARBO at AUC 2) and 98.2% completed RT without any treatment related death. Higher grades of neutropenia (33.3%) and hyponatremia (17.5%) with CIS and hypercreatinemia (10.5%) with CARBO was noted. Tube dependence (gastrostomy/tracheostomy) had 2.7-fold increase in risk of death in pts (n = 25; 44%) with hypopharynx/larynx cancer, compared with stage and subsite matched pair analysis in pts < 60 years. Factors predicting good PFS were ECOG (1 vs 2) HR = 0.25 (95%CI:0.09-0.70), Completion of treatment without any breaks while on CCRT, HR = 2.54 (95%CI:1.02-6.32, p = 0.04), and age in 70-75 years, HR = 1.09 (adjusted for alcohol and smoking) (95%CI: 1.01-1.20, p = 0.08). Factors suggestive of poor PFS were hyponatremia, hypercreatinemia and weight loss > 3kgs from their baseline. PFS (80%) in pts with stage III and IV disease was 22 (95%CI: 12.4-87.2) months and 15.53 (95%CI: 8.6-20.6) months respectively.
Curative intent CCRT should be considered as standard of care in elderly patients > 70 years with good ECOG status. Both cisplatin and carboplatin showed significant benefit in PFS with fewer side effects. Aggressive swallowing rehabilitation, abstinence from smoking and alcohol are likely to improve outcomes.
Clinical trial identification
This is a retrospective study and not a clinical trial
Legal entity responsible for the study
Amrita Institute of Medical Sciences
All authors have declared no conflicts of interest.