Chemoradiotherapy improves survival in some elderly patients with head, neck cancer

The addition of chemotherapy to radiation therapy improved survival among elderly patients with head and neck cancer who were aged 71 to 79 years and had low comorbidity scores, according to findings presented at the Multidisciplinary Head and Neck Cancers Symposium.

Concurrent chemoradiation is the standard treatment for the curative management of locally advanced head and neck cancer.

Sana Karam, MD, PhD

A previous meta-analysis demonstrated a decreased survival benefit with age, specifically among patients aged older than 70 years. However, that age group represented only 4% of the total cohort.

Thus, Sana Karam, MD, PhD, assistant professor of radiation oncology at University of Colorado School of Medicine, and colleagues sought to evaluate whether the addition of chemotherapy to radiation alone confers a survival benefit in patients aged older than 70 years.

Karam and colleagues used the National Cancer Data Base to identify patients with head and neck cancers diagnosed between 1998 and 2011. Twenty-three percent of patients diagnosed during that time were aged older than 70 years.

Of that cohort, 1,504 patients had been treated with radiotherapy alone and 2,538 patients had concurrent chemoradiation. All patients received 66 to 81.6 Gy definitive radiation in 1.2 to 2 Gy fractions. Those who also received chemotherapy did so within 14 days of the start of radiation.

Overall, a greater proportion of patients who received radiation achieved 5-year OS than those who received chemotherapy alone (30.3% vs. 15.2%; HR = 0.59; 95% CI, 0.55-0.63).

“Our results showed clearly that there is a significant overall survival benefit from the addition of concurrent chemoradiation,” Karam said during a press briefing.

Results of a propensity score-match analysis also showed a significant 5-year OS advantage with chemoradiation (26.4% vs. 18.1%; HR = 0.73; 95% CI, 0.66-0.8).

“To further guide [standard] clinical practice … we did a recursive partitioning analysis to answer the question of whether everyone benefits from concurrent chemotherapy because we know the addition of chemotherapy to radiation increases toxicity,” Karam said.

This allowed the investigators to stratify patients into subgroups and assess the survival benefit even further.

Results showed chemoradiation therapy improved survival among patients aged younger than 80 years (HR = 0.8; P = .001), with comorbidity scores of 0 or 1 (HR = 0.84; P = .002) and advanced disease (T1-2/N2-3 or T3-4/N0-3; HR = 0.77; P ˂ .001). Receipt of intensity-modulated radiation also improved OS (HR = 0.76; P ˂ .002).

However, radiation did not confer a survival benefit among patients aged older than 79 years (HR = 0.93), those with a comorbidity score of 2 or higher (HR = 1), those with T-stage I or II disease (HR = 1.09), and those who received 3-D radiation (HR = 1.02).

“So the question is, ‘Does age matter?’” Karam said. “The answer is both yes and no. But the main takeaway is: Do not just look at the age of the patient. In this day and age in which patients are healthier and living longer, give them the benefit of curative intent with the addition of chemotherapy.

“Assess them clinically,” Karam added. “If they are not healthy or have poor scores, then it’s OK to just give radiation therapy alone, but the addition of chemotherapy can improve survival dramatically in some patients who are considered elderly.” – by Anthony SanFilippo

Reference:

Amini A, et al. Abstract 100. Presented at: Multidisciplinary Head and Neck Cancer Symposium; Feb. 18-19, 2016; Scottsdale, Ariz.

Disclosure: The researchers report no relevant financial disclosures.