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. 2015 Jun 15;121(12):2083-9.
doi: 10.1002/cncr.29262. Epub 2015 Feb 27.

Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis

Caitriona B O'Neill  1   2 , Shrujal S Baxi  3 , Coral L Atoria  1 , James P O'Neill  4 , Martin C Henman  2 , Eric J Sherman  3 , Nancy Y Lee  5 , David G Pfister  3 , Elena B Elkin  1
Affiliations

Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis

Caitriona B O'Neill et al. Cancer. .

Abstract

Background: Despite advantages in terms of cancer control and organ preservation, the benefits of chemotherapy and radiation therapy (CTRT) may be offset by potentially severe treatment-related toxicities, particularly in older patients. The objectives of this study were to assess the types and frequencies of toxicities in older adults with locally or regionally advanced head and neck squamous cell carcinoma (HNSCC) who were receiving either primary CTRT or radiation therapy (RT) alone.

Methods: With Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims, patients who were 66 years old or older with locally advanced HNSCC, were diagnosed from 2001 to 2009, and received CTRT or RT alone were identified. Differences in the frequency of toxicity-related hospital admissions and emergency room visits as well as feeding tube use were examined, and controlling for demographic and disease characteristics, this study estimated the impact of chemotherapy on the likelihood of toxicity.

Results: Among patients who received CTRT (n = 1502), 62% had a treatment-related toxicity, whereas 46% of patients who received RT alone (n = 775) did. When the study controlled for demographic and disease characteristics, CTRT patients were twice as likely to experience an acute toxicity in comparison with their RT-only peers. Fifty-five percent of CTRT patients had a feeding tube placed during or after treatment, whereas 28% of the RT-only group did.

Conclusions: In this population-based cohort of older adults with HNSCC, the rates of acute toxicities and feeding tube use in patients receiving CTRT were considerable. It is possible that for certain older patients, the potential benefit of adding chemotherapy to RT does not outweigh the harms of this combined-modality therapy.

Keywords: Epidemiology; Medicare; Surveillance; and End Results (SEER); chemoradiation; head and neck cancer; radiotherapy; toxicity.

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Figures

Figure 1
Figure 1. Trends in use of CTRT and RT only
Figure shows the proportion of all patients with locally or regionally advanced HNSCC who received CTRT vs. RT only Abbreviations: CTRT, chemoradiation; RT, radiation therapy
See this image and copyright information in PMC

References

    1. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. International Journal of Cancer. 2001;94(2):153–156. - PubMed
    1. American Cancer Society (ACS) 2012. Cancer Facts and Figures 2012. Atlanta: American Cancer Society; 2012.
    1. Seiwert TY, Salama JK, Vokes EE. The chemoradiation paradigm in head and neck cancer. Nat Clin Prac Oncol. 2007;4(3):156–171. - PubMed
    1. Michal SA, Adelstein DJ, Rybicki LA, et al. Multi-agent concurrent chemoradiotherapy for locally advanced head and neck squamous cell cancer in the elderly. Head Neck. 2012 Aug;34(8):1147–1152. - PubMed
    1. Adelstein DJ, Saxton JP, Rybicki LA, et al. Multiagent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2006 Mar 1;24(7):1064–1071. - PubMed

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