Rivoirard Romain, Moncharmont Coralie, Assouline Avi, Auberdiac Pierre, Mery Benoite, Falk Alexander Tuan, Annède Pierre, Trone Jane-Chloé, Guy Jean-Baptiste, Vial Nicolas, Fournel Pierre, Merrouche Yacine, Chargari Cyrus, Magné Nicolas
Department of Medical Oncology, Institut Lucien Neuwirth, St Priest en Jarez Cedex, France.
Eur Arch Otorhinolaryngol. 2015 Mar;272(3):719-25. doi: 10.1007/s00405-014-3017-3. Epub 2014 Apr 2.
In the field of radiotherapy, there is very little scientific data on the management of nonagenarians, especially in patients aged 90 years or more and with head and neck cancer (HNC). We made one of the first retrospective study of the feasibility and safety of radiotherapy in this population with HNC. Records of radiotherapy coming from four health facilities were studied to include all nonagenarian patients with HNC in the last 10 years and who received radiation therapy. We analyzed patient characteristics and primary cancers, as well as objective of the treatment (curative or palliative), efficacy and toxicity. Twenty patients receiving radiotherapy were identified; mean age was 93.2 years (standard deviation 2.8). Treatment was given with curative and palliative intent in 40 and 60 % of cases, respectively. The most common primary tumors were tumors of the salivary glands (30 % of cases), oral cavity tumors (25 % of cases) and thyroid tumors (15 % of cases). Median total prescribed dose was 47.5 Gy (12-70 Gy). Median number of delivered fractions was 18.5 (2-35 fractions). All patients received intensive supportive care during radiotherapy. Toxicities were mild to moderate. Radiotherapy could not be completed for four patients (20 % of cases). One patient developed grade 1-2 delayed toxicities. At the last follow-up, only four patients (20 % of cases) were alive. Cancer was cause of death in most cases. Radiotherapy may be performed for the nonagenarians with HNC. The total dose and fractionation must be adjusted to optimize the tolerance. However, the prognosis remains very poor, cancer being the main cause of death. Research of geriatric vulnerabilities prior to any treatment, in the context of a comprehensive geriatric assessment, is still recommended to select patients for radiotherapy.
在放射治疗领域，关于九旬老人治疗管理的科学数据非常少，尤其是90岁及以上且患有头颈癌（HNC）的患者。我们首次对该HNC人群进行了放射治疗可行性和安全性的回顾性研究。研究了来自四个医疗机构的放射治疗记录，纳入过去10年中所有接受放射治疗的九旬HNC患者。我们分析了患者特征、原发癌，以及治疗目的（根治性或姑息性）、疗效和毒性。共确定了20例接受放射治疗的患者；平均年龄为93.2岁（标准差2.8）。分别有40%和60%的病例治疗目的为根治性和姑息性。最常见的原发肿瘤是唾液腺肿瘤（30%的病例）、口腔肿瘤（25%的病例）和甲状腺肿瘤（15%的病例）。总处方剂量中位数为47.5 Gy（12 - 70 Gy）。照射分次次数中位数为18.5次（2 - 35次）。所有患者在放疗期间均接受了强化支持治疗。毒性为轻至中度。4例患者（20%的病例）未能完成放疗。1例患者出现1 - 2级迟发性毒性。在最后一次随访时，仅4例患者（20%的病例）存活。大多数病例中癌症是死亡原因。对于九旬HNC患者可以进行放射治疗。必须调整总剂量和分割方式以优化耐受性。然而，预后仍然非常差，癌症是主要死亡原因。在综合老年评估的背景下，仍建议在任何治疗前研究老年脆弱性以选择适合放疗的患者。
