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. 2025 Nov 2;17(21):3550.
doi: 10.3390/cancers17213550.

Retrospective Trial on Cetuximab Plus Radiotherapy in Elderly Patients with Head and Neck Squamous Cell Cancer

Morena Fasano  1 , Francesco Perri  2 , Mario Pirozzi  3   4 , Chiara Lucrezia Deantoni  5 , Davide Valsecchi  6 , Alessio Cirillo  7 , Raffaele Addeo  8 , Pasquale Vitale  8 , Francesca De Felice  7 , Paolo Tralongo  9 , Stefano Farese  1 , Beatrice Ruffilli  3   4 , Fabrizio Romano  9 , Mathilda Guizzardi  10 , Leone Giordano  10 , Monica Pontone  2 , Maria Luisa Marciano  2 , Fabiana Raffaella Rampetta  2 , Francesco Longo  11 , Fortunato Ciardiello  1 , Aurora Mirabile  10
Affiliations

Retrospective Trial on Cetuximab Plus Radiotherapy in Elderly Patients with Head and Neck Squamous Cell Cancer

Morena Fasano et al. Cancers (Basel). .

Abstract

Background: A wide percentage (25-40%) of patients affected by head and neck squamous cell carcinoma (HNSCC) are over 70 years old, and they present with different characteristics if compared to younger patients. Elderly patients often receive less intensive, non-surgical, and non-multimodal treatments. Although age does not mean frailty, the elderly are at a higher risk of developing toxicity. In fact, several studies enrolling patients treated with cisplatin + radiotherapy (CISPLATIN + RT) or cetuximab + radiotherapy (Cet + RT) showed reduced efficacy over 65 years.

Methods: We conducted a multicenter retrospective analysis in patients with Locally Advanced HNSCC aged over 65 years, who underwent Cet-RT, diagnosed in the period between 2017 and 2024. The primary endpoint was to describe Overall Survival (OS), the secondary endpoints were Progression Free Survival (PFS) and the percentage and type of Adverse Events (AEs). Patients received a geriatric assessment using the G8 questionnaire.

Results: Data regarding Eighty-Two (82) patients were analyzed, median age was 74 years (range 65-84), most patients had oral cavity (26.8%) and laryngeal cancer (37.8%). Fifty-six point one (56.1%) of patients were smokers, and 17.1% reported alcohol consumption. All patients completed radiotherapy, and 80.5% of them developed AEs, which in 25.6% of cases were G3-4 toxicities. No relationship was found between G3-4 AEs and age (p = 0.596), G8score < 14 (p = 0.804), and smoking (p = 0.245)/drinking habits (p = 0.341). Median OS was 58 months, with a slightly non-significant positive trend in OS for patients who were non-smokers and those who did not develop G3-4 AEs (p = 0.786 and 0.799, respectively). Association between folliculitis and OS was statistically significant (p = 0.001).

Conclusions: In elderly patients, Cet-RT represents a feasible, well-tolerated option, although further prospective studies are needed.

Keywords: HNSCC; cetuximab; elderly; geriatric assessment; radiotherapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overall survival (OS) Kaplan–Meier in the whole population.
Figure 2
Figure 2
(A) Overall survival (OS) Kaplan–Meier stratified per smoking, (B) alcohol consumption (C) G3–4 adverse events.
Figure 2
Figure 2
(A) Overall survival (OS) Kaplan–Meier stratified per smoking, (B) alcohol consumption (C) G3–4 adverse events.
Figure 3
Figure 3
Forest plot of the association between toxicity and survival according to grade and type of AEs.
Figure 4
Figure 4
Progression-free survival Kaplan–Meier curve.
See this image and copyright information in PMC

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