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Increased acute mortality with chemoradiotherapy for locally advanced head and neck cancer in patients ≥70years.
- Source :
-
Journal of geriatric oncology [J Geriatr Oncol] 2017 Jan; Vol. 8 (1), pp. 50-55. Date of Electronic Publication: 2016 Oct 03. - Publication Year :
- 2017
-
Abstract
- Purpose: Concurrent chemoradiotherapy (CRT) is the standard of care for many sites of locally advanced head and neck squamous cell carcinomas (LAHNC). However, on meta-analysis, the addition of chemotherapy did not improve survival for patients >70years. We hypothesized that elderly patients treated with CRT would have increased toxicity without similar improvements in survival.<br />Methods: A single-institution, IRB-approved retrospective study took place from 2005 to 2012 including 369 patients treated with CRT for LAHNC. Multivariate models for death at 3months and death over time were developed using logistic regression and Cox modeling, respectively.<br />Results: Patients ≥70years were treated less often with concurrent cisplatin dosed every 3weeks (25.5% vs. 71.4%, respectively) and more often with weekly carboplatin (31.9% vs. 3.4%) than patients <70years (n=322; p<0.001). Patients ≥70years experienced increased toxicity during treatment with more frequently hospitalizations (36.2% vs. 21.1%; p=0.02) and a lower rate of PEG removal at last follow-up or death (77.1% vs. 92.9%; p=0.004). A higher proportion of patients ≥70years died within 3months (12.8% vs. 2.8%; p=0.001) following CRT. Patients ≥70 had an increased risk of death at 3months following CRT (odds ratio 5.19, 95% CI 1.64-16.41; p=0.005) and worse survival over time (hazard ratio 2.30, 95% CI 1.34-3.93; p=0.002).<br />Conclusions: Patients ≥70years were more often treated with less toxic chemotherapy, yet experienced higher rates of hospitalization during treatment and increased rates of acute mortality following CRT. The efficacy of chemoradiotherapy for elderly patients should be evaluated in a prospective setting.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Age Factors
Aged
Aged, 80 and over
Carboplatin therapeutic use
Carcinoma, Squamous Cell mortality
Cisplatin therapeutic use
Deglutition Disorders
Female
Head and Neck Neoplasms mortality
Hospitalization statistics & numerical data
Humans
Logistic Models
Male
Middle Aged
Mortality
Multivariate Analysis
Proportional Hazards Models
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
Survival Rate
Antineoplastic Agents therapeutic use
Carcinoma, Squamous Cell therapy
Chemoradiotherapy
Head and Neck Neoplasms therapy
Radiotherapy, Intensity-Modulated methods
Subjects
Details
- Language :
- English
- ISSN :
- 1879-4076
- Volume :
- 8
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of geriatric oncology
- Publication Type :
- Academic Journal
- Accession number :
- 27720129
- Full Text :
- https://doi.org/10.1016/j.jgo.2016.09.003