Age alone should not be a deterrant to concurrent chemoradiotherapy (CRT) for the treatment of head and neck squamous cell carcinoma (HNSCC) in elderly patients. Additional factors to consider include performance status and tumor stage, a study published in the journal Cancer has shown.1
Because benefit of CRT for elderly patients with HNSCC is controversial, these researchers sought to determine the impact of CRT vs radiotherapy (RT) alone on overall survival (OS) in patients older than 70 years with HNSCC.
For the study, the researchers queried the National Cancer Data Base for patients older than 70 years with nonmetastatic oropharyngeal, laryngeal, or hypopharyngeal cancer (T3-4 or N[+]). Their search yielded 4042 patients, 2538 (63%) of whom received CRT, with a median follow-up of 19 months.
Chemoradiotherapy was defined for this study as chemotherapy started within 14 days of initiating RT. Analyses of the data were performed using univariate analysis, multivariate analysis, propensity score matching, and recursive partitioning analysis.
The addition of CRT resulted in a longer unadjusted median OS (P<.001). Multivariate analysis and propensity score matching analysis showed improved OS with CRT compared with RT alone (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.58-0.68; P<.001; and HR, 0.73; 95% CI, 0.66-0.80; P<.001, respectively). Recursive partitioning analysis showed an association between CRT and longer OS for patients 81 years or younger with low comorbidity scores and either T1-2/N2-3 disease or T3-4/N0-3 disease.
Survival benefit of CRT was lost for 2 subgroups among patients age 71 to 81 years: those with T1-2, N1, and Charlson-Deyo 0-1 (CD0-1) disease and those with T3-4, N1+, and CD1+ disease. CRT did not increase OS for patients older than 81 years. A longer duration of RT was associated with receiving CRT (odds ratio, 1.74; 95% CI, 1.50-2.01; P<.001).
1. Amini A, Jones BL, McDermott JD, et al. Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base [published online ahead of print March 11, 2016]. Cancer. doi:10.1002/cncr.29956.