Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
Department of Radiation Oncology, University of Kansas School of Medicine, Kansas City, Kansas.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):767-774. doi: 10.1016/j.ijrobp.2017.01.209. Epub 2017 Jan 29.
To compare patterns of care for elderly patients aged ≥70 years with locally advanced head and neck cancer versus those of younger patients treated for the same disease.
The medical records of 421 consecutive patients over the age of 50 years treated at a single institution between April 2011 and June 2016 for stage III/IV squamous cell carcinoma of the head and neck were reviewed. The primary treatment approach was compared using a t test statistic among 3 age cohorts: 50 to 59 years (118 patients); 60 to 69 years (152 patients); and 70 years and older (151 patients). Logistical regression was used to determine variables that influenced the likelihood of receiving surgery versus nonsurgical treatment, as well as radiation alone versus chemoradiation.
There was no difference in sex, T stage, N stage, Karnofsky performance status, or the number of chronic comorbid conditions among the 3 age cohorts (P>.05 for all). A greater proportion of elderly patients aged ≥70 years were treated by radiation alone compared with those aged 50 to 59 and 60 to 69 years (44% vs 16% and 24%, P=.01). Increasing age was associated with a greater likelihood of receiving primary nonsurgical versus surgical treatment (odds ratio 1.023, 95% confidence interval 1.004-1.042) and radiation alone compared with chemoradiation (odds ratio 1.054; 95% confidence interval 1.034-1.075). Ten chemotherapy regimens were used concurrently with radiation for patients aged ≥70 years, including carboplatin/paclitaxel (19%), carboplatin/cetuximab (19%), cisplatin (17%), and cetuximab (17%).
Despite similar performance status and comorbidity burden compared with their younger counterparts, patients aged ≥70 years were more commonly treated with less-aggressive strategies, including radiation alone. The variability of concurrent chemotherapy regimens used further suggests that the standard of care remains to be defined for this population.
比较≥70 岁的老年局部晚期头颈部癌患者与相同疾病的年轻患者的治疗模式。
对 2011 年 4 月至 2016 年 6 月在一家机构接受治疗的年龄在 50 岁以上的 421 例连续患者的病历进行回顾性研究。使用 t 检验统计比较了 3 个年龄组之间的主要治疗方法：50-59 岁（118 例）；60-69 岁（152 例）；70 岁及以上（151 例）。采用逻辑回归确定影响接受手术与非手术治疗以及单纯放疗与放化疗可能性的变量。
3 个年龄组之间的性别、T 分期、N 分期、卡氏功能状态或慢性合并症数量均无差异（所有 P>.05）。与 50-59 岁和 60-69 岁的患者相比，≥70 岁的老年患者中接受单纯放疗的比例更高（44%比 16%和 24%，P=.01）。年龄增加与接受主要非手术治疗而非手术治疗的可能性增加相关（优势比 1.023，95%置信区间 1.004-1.042），与接受放化疗相比，接受单纯放疗的可能性增加（优势比 1.054；95%置信区间 1.034-1.075）。对于≥70 岁的患者，有 10 种化疗方案与放疗同时使用，包括卡铂/紫杉醇（19%）、卡铂/西妥昔单抗（19%）、顺铂（17%）和西妥昔单抗（17%）。
尽管与年轻患者相比，≥70 岁的患者在表现状态和合并症负担方面相似，但他们更常接受不那么激进的治疗策略，包括单纯放疗。同时使用的化疗方案的多样性进一步表明，这一人群的治疗标准仍有待确定。
