1478 - Treatment outcomes of head and neck cancer patients 70 years and older receiving different chemo-radiation combinations.

Background

Concurrent chemoradiation (CRT) improves survival in squamous cell carcinoma of the head and neck (HNSCC). Little is known about the outcomes of elderly patients (pts, ≥70 years old) in terms of treatment efficacy and side effects. This retrospective study compares acute toxicity, response to therapy, and overall survival between elderly pts receiving different CRT combinations.

Methods

Pts. without dementia, deficit on instrumental activities of daily living, Charlson comorbidity index <2, and living at home with a family member received CRT. Pts received one of the following: 1) weekly carboplatin AUC 1 and paclitaxel 30mg/m2 for seven doses (CP), 2) cetuximab loading dose of 400 mg/m² followed by 250 mg/m² weekly for seven doses (CE), 3) weekly carboplatin AUC 1.5 for seven doses (CB), 4) weekly cisplatin 40 mg/m2 for seven doses (CIS). Radiation was administered to a dose of 70 Gy as definitive treatment or 66 Gy as adjuvant treatment (2 Gy/fraction).

Results

150 pts. (M/F: 111/39) with mean age 74.6 (range 70-88) were identified. 52 pts (34.7%) received adjuvant and 98 (65.3%) definitive CRT. Tumor site: oropharynx 74 (49.5%), oral cavity (17.5%), larynx 14%, others (19%). 60 pts (40%) were p-16 positive. 44 patients (29.5%) received CP, 43 (28.5%) CE 33 (22%) CB, and 30 (20%) CIS. 110 pts (73.5%) had a complete response (CR). 90 pts (60%) were admitted to the hospital during CRT, and pneumonia was the most common diagnosis (59 pts, 39.5%). 98 pts (65.5%) had percutaneous endoscopic gastrostomy tube (PEG) due to G3 mucositis. Two patients (1.3%) experienced G5 cardiovascular toxicity. At 6 months, 38 (25.3%) still had PEG, and was associated with CRT regimen (p = 0.001): 6/44(14%) received CP, 22/43 (51%) CE, 4/33 (12%) CB, and 6/30 (20%) CIS. The overall survival at 3 yrs was 60% (95% confidence interval (CI), 52%-71%). The predictors for OS at 3 yrs were response to therapy (CR 78% (68%-88%), and non-CR 17% (7%-37%); P < 0.0001), and CRT regimen (CB 41% (25%- 66%) vs others 66%, (57%- 78%); P = 0.01).

Conclusions

CRT can be administered to a selected elderly population with HNSCC. Single agent CB was associated with worse outcomes. CE seems to be related to a higher rate of long term PEG dependence.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The Ohio State University, James Cancer Hospital and Solove Research Institute.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.