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Benefit of aggressive multiagent concurrent chemoradiotherapy for SCCHN similar despite patient age
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Age alone was not a factor for considering aggressive multiagent concurrent chemoradiotherapy for the treatment of patients with head and neck squamous cell cancer.
Patients aged 70 years or older had more myelosuppression and supportive care requirements when undergoing this aggressive treatment; however, disease-specific survival, recurrence rate and patterns of failure were comparable with that of patients aged younger than 70 years.
“Over the past few decades, the use of concurrent chemoradiotherapy has been found to improve survival in patients with locally advanced head and neck squamous cell cancer,” said Stephanie A. Michal, MD, of the Cleveland Clinic.
However, findings from a previously reported meta-analysis indicated a reduced benefit of multiagent concurrent chemoradiotherapy with increasing patient age. To examine this trend, researchers conducted a retrospective review of 44 patients aged 70 years or older who had been treated with multiagent concurrent chemoradiotherapy between 1989 and 2007 at the Cleveland Clinic and compared the data with that of a control group of 137 patients aged younger than 70 years.
Treatment included a four-day continuous IV infusion of fluorouracil 1,000 mg/m 2 per day and cisplatin 20 mg/m2 per day during weeks one and four of daily or twice daily radiation therapy at doses of 68 Gy to 74.4 Gy.
Patients in the older age group were less likely to receive the second cycle of chemotherapy (82% vs. 96%; P< .001) and were less likely to be radiated twice daily (30% vs. 72%; P<.001). Grade-3 to grade-4 toxicities were similar between groups and included nausea/vomiting and mucosal and skin reactions.
Patients aged 70 years or older had lower mean nadir granulocyte than younger patients (750 mm3 vs. 1,040 mm3; P=.06) and required more unplanned hospitalization during treatment compared with younger patients (84% vs. 67%; P=.031). Platelet counts were also lower than in younger patients (80 K/mm3 vs. 112 K/mm3; P=.001).
During a median follow-up of 62 months for older patients and 61 months for younger patients, the five-year disease-specific survival rate was 71% in the older patients group vs. 74% for those aged younger than 70 years. Freedom from recurrence was 69% in older patients and 71% in younger patients.
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