Adding chemotherapy to radiation therapy improves survival among elderly patients with head and neck cancers who are age 71 to 79 years, have low comorbidity scores, and have advanced-stage disease. These findings were presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium.1
The study used the National Cancer Database to analyze 5265 patients older than 70 years with nonmetastatic oropharynx, larynx, and hypopharynx cancers treated from 1998 to 2011. Among these patients, 3604 (68%) received radiation therapy alone and 1661 (32%) received chemoradiation therapy (CRT).
“Elderly patients have been underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer,” said senior author Sana Karam, MD, PhD, an assistant professor of radiation oncology at the University of Colorado School of Medicine in Aurora. “Our study drew on nationwide data to assess more comprehensively how combined therapy impacts this population.”
Compared with radiation therapy alone, chemoradiation therapy was associated with improved survival following HNSCC in patients ages 79 years and younger (hazard ratio [HR], 0.80; P = .001), with comorbidity scores of 0 or 1 (HR, 0.84; P = .002), and advanced-stage disease (ie, either T1-2/N2-3 or T3-4/N0-3 disease [HR, 0.77; P < .001]). Findings also demonstrated an overall survival benefit of chemoradiation therapy for patients treated with intensity-modulated radiation therapy (HR, 0.76; P = .002).
Those patients who did not see an overall survival benefit from chemoradiation therapy tended to be 79 years or older (HR, 0.93, P = .368), had a comorbidity score of 2 or greater (HR, 1.00, P = .992), presented with T-stage 1 or 2 disease (HR, 1.09, P = .448), or were treated with 3-dimensional RT (HR, 1.02, P = .923). Patients age 79 years or older with multiple comorbidities trended toward worse overall survival with chemoradiation therapy, though the difference was only marginally significant (HR, 2.36; P = .080).
These findings may help clinicians discuss treatment options with elderly patients with head and neck cancer.
“Because the toxicity of concurrent chemoradiation is greater than radiation alone for definitive HNSCC treatment, many clinicians have reservations about offering CRT for elderly head and neck cancer patients,” said Karam. “However, in the era of improved radiation techniques, improved systemic therapy, and better supportive care, we find that CRT does, in fact, improve survival for a large segment of this population.”
1. Amini A, Jones B, McDermott J, et al. Does age matter? Survival outcomes with the addition of concurrent chemotherapy for elderly head and neck cancer patients undergoing definitive radiation using the National Cancer Data Base. Paper presented at: 2016 Multidisciplinary Head and Neck Cancer Symposium; Scottsdale, AZ; February 18-20, 2016. Abstract 100.