Chang Pei-Hung, Yeh Kun-Yun, Huang Jen-Seng, Chen Eric Yen-Chao, Yang Shih-Wei, Wang Cheng-Hsu
Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan.
Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan.
Asia Pac J Clin Oncol. 2015 Sep;11(3):228-35. doi: 10.1111/ajco.12323. Epub 2014 Dec 23.
To evaluate treatment tolerance, toxicities and survival in elderly patients with advanced head and neck cancer who received inpatient-based intensive nutritional support with concurrent chemoradiotherapy in comparison with younger patients undergoing the same treatment.
We retrospectively analyzed the records of 126 stage III, IVA and IVB head and neck cancer patients who were treated with concurrent chemoradiotherapy between 2007 and 2009 under an inpatient-based nutritional support program. The clinical characteristics, treatment tolerance, toxicities and survival of patients older than 65 years were compared with those of identically treated patients younger than 65 years.
There were 21 patients older than 65 years and 105 patients younger than 65 years. Clinical characteristics and treatment toxicities were similar between the groups, except that the elderly were less likely to tolerate cisplatin, experienced more weight loss, required more feeding tube support and tended to have >grade 3 hematological toxicities and to develop sepsis during the period of chemoradiotherapy. The 1- and 2-year disease-free survival and disease-specific survival rates were nearly identical.
Age alone should not be considered a contraindication to aggressive chemoradiotherapy for advanced head and neck cancer. Older patients require more careful multidisciplinary assessment of their supportive care needs to ensure successful completion of treatment and avoid further treatment-related toxicity.
评估接受住院强化营养支持并行放化疗的老年晚期头颈癌患者与接受相同治疗的年轻患者相比的治疗耐受性、毒性反应及生存率。
我们回顾性分析了2007年至2009年间在住院营养支持项目下接受同步放化疗的126例III、IVA和IVB期头颈癌患者的记录。将65岁以上患者的临床特征、治疗耐受性、毒性反应及生存率与接受相同治疗的65岁以下患者进行比较。
65岁以上患者21例，65岁以下患者105例。两组的临床特征和治疗毒性反应相似，但老年患者对顺铂的耐受性较低，体重减轻更多，需要更多的鼻饲管支持，且在放化疗期间更易出现3级以上血液学毒性反应及发生败血症。1年和2年无病生存率及疾病特异性生存率几乎相同。
年龄本身不应被视为晚期头颈癌积极放化疗的禁忌证。老年患者需要更仔细地进行多学科评估以确定其支持治疗需求，以确保治疗成功完成并避免进一步的治疗相关毒性反应。
