Abstract 875P
Background
Geriatric patients with LAHN-SCC are under-represented in clinical trials and denied standard treatment with concurrent chemo-radiation. Most are treated with radiotherapy (RT) alone. However, with the use of intensity modulated radiotherapy (IMRT) and good supportive care, even this cohort of patients can be considered for chemo-radiation.
Methods
69 patients with age >65 years with LA-HNSCC treated between April 2015 and December 2019 in our Institute were retrospectively evaluated for treatment compliance and outcomes. All patients were planned to receive 70Gy in 33-35 fractions with simultaneous integrated boost -IMRT and concurrent weekly cisplatin at a dose of 40mg/m2 or carboplatin AUC 2. Overall survival (OS) and prognostic factors were evaluated using SPSS version 16.
Results
Median age at presentation was 67 years (65-81). 54 were male. 63.7% had KPS of >90. Primary site of presentation were oropharynx (29), hypopharynx (27) and larynx (13). 12 (17.3%) had co-morbid conditions. Primary tumour status: T2/T3/T4 - 14/46/8; Nodal status: N0/N1/N2/N3 – 16/23/27/3. 37 (53.6%) had stage III disease. Median baseline haemoglobin was 12g/dl (7.5-18). 5 had feeding tube and 3 had tracheostomy tube. All patients completed planned 70 Gy in 33-35 fractions. 44 received cisplatin and 25 received carboplatin. 56 (81%) of patients received at least 5 (>200mg/m2) or more chemotherapy cycles, median of 6 cycles. Median overall treatment time was 50 days (42-65 days). Grade 3 toxicity was seen only as neutropenia/mucositis/laryngitis/pharyngitis in 5.7%/16%/4.3%/14.4%, respectively. Mean weight loss was 8.7% (0-17%). Overall response rate was 97.1%, 44 (63.7%) had complete response. With median follow up of 23.6 months (3-71), OS was 53.5%. Estimated 3-year and 5-year OS were 41.3% and 34.3%, respectively. On univariate analysis age less than 70 years, use of cisplatin, N0-N1, stage III and complete response to treatment showed good OS (p value <0.05). On multivariate analysis only age (p =0.03) and complete response to treatment had good OS (p =0.00). Four patients developed second primary cancer.
Conclusions
Definitive chemo-IMRT approach in Geriatric LAHN-SCC is well tolerated with acceptable clinical outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.