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. 2017 Apr 15;123(8):1345-1353.
doi: 10.1002/cncr.30495. Epub 2016 Dec 16.

The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era

Zachary S Zumsteg  1   2 , Benjamin H Lok  3 , Allen S Ho  2   4 , Esther Drill  5 , Zhigang Zhang  5 , Nadeem Riaz  3 , Stephen L Shiao  1   2 , Jennifer Ma  3 , Sean M McBride  3 , C Jillian Tsai  3 , Shrujal S Baxi  6 , Eric J Sherman  6 , Nancy Y Lee  3
Affiliations

The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era

Zachary S Zumsteg et al. Cancer. .

Abstract

Background: Despite controversy surrounding its benefit, the use of concomitant chemoradiotherapy (CCRT) in patients with oropharyngeal squamous cell carcinoma (OPSCC) who are aged > 70 years is increasing. However, to the authors' knowledge, few studies to date have compared the outcomes of different systemic treatments in this population.

Methods: Records from 74 patients aged ≥ 70 years with stage III to stage IVB OPSCC who were undergoing CCRT from 2002 to 2013 at a single institution were reviewed. Patients were stratified according to the systemic therapy received, including cisplatin, carboplatin with either 5-fluorouracil or paclitaxel (CARB), or cetuximab to compare oncologic outcome and toxicity.

Results: The median follow-up was 36 months. The median age of the patients was 75.3 years (range, 70-91 years), with significantly older patients receiving cetuximab (P = .03). A total of 28, 20, and 26 patients, respectively, received CCRT with cisplatin, CARB, and cetuximab. RT interruptions of > 1 day were needed in 4% of patients receiving cisplatin, 20% of patients receiving CARB, and 15% of patients receiving cetuximab (P = .19). Unplanned hospitalizations during CCRT occurred in 25%, 55%, and 58%, respectively, of patients receiving cisplatin, CARB, and cetuximab (P = .03). There were 2 treatment-related deaths, both of which occurred among the patients who were treated with cetuximab. At 5 years, locoregional control was achieved in 100%, 88%, and 60% (P<.001), respectively, and the overall survival rate was 87%, 61%, and 47% (P = .03), respectively, among patients treated with cisplatin, CARB, and cetuximab.

Conclusions: Toxicity from CCRT remains a challenge for older adults with OPSCC. Herein, the authors found no evidence that this toxicity was mitigated by treatment with cetuximab. Nevertheless, a subset of patients aged ≥70 years appear to tolerate cisplatin-based treatment with acceptable toxicity and excellent outcomes. Further identification of this patient subgroup is crucial to optimize therapy for older patients with OPSCC. Cancer 2017;123:1345-1353. © 2016 American Cancer Society.

Keywords: cetuximab; chemoradiation; elderly; human papillomavirus (HPV); oropharyngeal squamous cell carcinoma.

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Conflict of interest statement

The authors have no conflicts of interest related to this work.

Figures

Figure 1
Figure 1
A) Local control, B) distant-metastasis free survival, and C) cause-specific mortality, and D) overall survival stratified by type of systemic therapy received in patients aged 70 or older with oropharyngeal squamous cell carcinoma.
Figure 1
Figure 1
A) Local control, B) distant-metastasis free survival, and C) cause-specific mortality, and D) overall survival stratified by type of systemic therapy received in patients aged 70 or older with oropharyngeal squamous cell carcinoma.
Figure 1
Figure 1
A) Local control, B) distant-metastasis free survival, and C) cause-specific mortality, and D) overall survival stratified by type of systemic therapy received in patients aged 70 or older with oropharyngeal squamous cell carcinoma.
Figure 1
Figure 1
A) Local control, B) distant-metastasis free survival, and C) cause-specific mortality, and D) overall survival stratified by type of systemic therapy received in patients aged 70 or older with oropharyngeal squamous cell carcinoma.
See this image and copyright information in PMC

References

    1. Pignon JP, le Maitre A, Maillard E, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol. 2009;92:4–14. - PubMed
    1. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11:21–8. - PubMed
    1. Bourhis J, Overgaard J, Audry H, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet. 2006;368:843–54. - PubMed
    1. Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582–3589. - PMC - PubMed
    1. Argiris A, Li Y, Murphy BA, et al. Outcome of elderly patients with recurrent or metastatic head and neck cancer treated with cisplatin-based chemotherapy. J Clin Oncol. 2004;22:262–268. - PubMed

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