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2016 Head and Neck Cancer Symposium: Chemoradiation May Increase Survival for a Subset of Elderly Head and Neck Cancer Patients

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Key Points

  • Compared to radiation therapy alone, chemoradiation therapy was associated with improved survival following head and neck squamous cell carcinoma in patients age 79 and younger, with comorbidity scores of 0 or 1, and advanced disease stage.
  • Findings also demonstrated an overall survival benefit of chemoradiation therapy for patients treated with intensity-modulated radiation therapy.
  • Patients who did not see an overall survival benefit from chemoradiation tended to be aged 79 or older, had a comorbidity score of 2 or greater, presented with T1 or T2 disease, or were treated with three-dimensional radiation therapy.

The addition of chemotherapy to radiation therapy improves survival rates among a subset of elderly head and neck cancer patients, specifically those aged 71 to 79 with low comorbidity scores and advanced disease stage, according to research presented by Amini et al at the 2016 Multidisciplinary Head and Neck Cancer Symposium (Abstract 100).

Drawing on nationwide population-based data, the study demonstrated a survival benefit of chemoradiation therapy similar to that for younger head and neck squamous cell carcinoma patients among septuagenarians with limited comorbidity and later-stage disease. Chemoradiation therapy did not predict survival improvement in patients aged 80 and above or those with earlier-stage disease or multiple comorbidities.

While previous research has demonstrated the efficacy of combining concomitant chemotherapy with radiation therapy to improve survival for patients with head and neck squamous cell carcinoma, this improvement has not been shown in patients older than 70 years. In particular, a 2009 meta-analysis of 16,485 patients in 87 randomized trials found that benefits of chemoradiation therapy for locally advanced head and neck squamous cell carcinoma decreased with age and concluded no overall survival benefit for patients aged 71 and above. Patients in this age range totaled only 4% of the population in the meta-analysis, however, whereas individuals aged 71 and above accounted for more than 9% of the 2010 U.S. Census.

“Elderly patients have been underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer,” said Sana Karam, MD, PhD, Assistant Professor of Radiation Oncology at the University of Colorado School of Medicine. “Our study drew on nationwide data to assess more comprehensively how combined therapy impacts this population.”

Study Background

The authors queried the National Cancer Data Base for records of patients older than 70 years who were treated for nonmetastatic oropharyngeal, laryngeal, and hypopharyngeal cancers between 1998 and 2011. Cases were divided into two groups based on whether or not patients received chemotherapy concurrent with radiation therapy. All patients received definitive radiation therapy (66.0–81.6 Gy in 1.2–2.0 Gy fractions), and concurrent chemoradiation was defined as beginning a course of chemotherapy within 14 days of the start of radiation therapy.

Sixty-eight percent of the patients received radiation therapy alone, and 32% received chemoradiation. Multivariate and propensity-score–matched analyses were used to compare overall survival outcomes between the cohorts, and researchers conducted recursive partitioning analysis based on overall survival to examine differences associated with age, Charlson comorbidity score, T stage, and N stage.

Key Findings

Compared to radiation therapy alone, chemoradiation therapy was associated with improved survival following head and neck squamous cell carcinoma in patients aged 79 and younger (hazard ratio [HR] = 0.80, P = .001), with comorbidity scores of 0 or 1 (HR = 0.84, P = .002), and advanced disease stage (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).

Patients who did not see an overall survival benefit from chemoradiation therapy tended to be age 79 or older (HR = 0.93, P = .368), had a comorbidity score of 2 or greater (HR = 1.00, P = .992), presented with T1 or T2 disease (HR = 1.09, P = .448), or were treated with three-dimensional radiation therapy (HR = 1.02, P = .923). Patients aged 79 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).

The findings may aid clinicians in discussing treatment options with their elderly head and neck squamous cell carcinoma patients. Moreover, results of this study could guide future prospective trials to confirm the benefit of multimodality treatment in elderly patients, not only for head and neck cancer but for other cancer sites as well.

“Because the toxicity of concurrent chemoradiation is greater than radiation alone for definitive head and neck squamous cell carcinoma treatment, many clinicians have reservations about offering chemoradiation therapy for elderly head and neck cancer patients,” said Dr. Karam. “However, in the era of improved radiation techniques, improved systemic therapy and better supportive care, we find that chemoradiation therapy does, in fact, improve survival for a large segment of this population.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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