Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Radiat Oncol. 2020 Feb 4;15(1):31. doi: 10.1186/s13014-020-1481-z.
Head-and-neck squamous cell carcinoma (HNSCC) is one of the most common malignancies globally, and the number of elderly patients diagnosed with HNSCC is increasing. However, as elderly HNSCC patients are underrepresented in clinical trials, current clinical decision making for this cohort largely lacks clinical evidence.
Elderly patients (≥65 years) with HNSCC undergoing (chemo)radiotherapy from 2010 to 2018 at Freiburg University Medical Center were assessed for patterns of care, locoregional control (LRC), progression-free (PFS) and overall survival (OS) regarding definitive and adjuvant treatments. Acute and late therapy-associated toxicities were quantified according to CTCAE v5.0.
Two hundred forty-six patients were included in this analysis, of whom 166 received definitive and 80 adjuvant treatment. Two-year rates for OS, PFS and LRC were 56.9, 44.9 and 75.5%, respectively. Survival differed significantly between age groups with an OS of 40 and 22 months and a PFS of 23 and 12 months for patients aged 65-74 or ≥ 75 years, respectively (p < 0.05). Concomitant chemotherapy resulted in improved OS in patients aged 65-74 years compared to radiotherapy alone (p < 0.05) for definitive treatments, while patients ≥75 years did not benefit (p = 0.904). For adjuvant chemoradiotherapy, a trend towards superior OS rates was observed for patients aged 65-74 years (p = 0.151). Low performance status (HR = 2.584, 95% CI 1.561-4.274; p < 0.001) and smoking (HR = 1.960, 95% CI 1.109-3.464, p < 0.05) were the strongest independent prognostic factor in the multivariate analysis for decreased OS. One hundred thirty-eight patients (56.1%) experienced acute grade 3/4 and 45 patients (19.9%) chronic grade 3 toxicities.
Radiotherapy is a feasible treatment modality for elderly HNSCC patients. The relatively low OS compared to high LRC may reflect age and comorbidities. Concomitant chemotherapy should be critically discussed in elderly HNSCC patients.
头颈部鳞状细胞癌（HNSCC）是全球最常见的恶性肿瘤之一，诊断为 HNSCC 的老年患者数量正在增加。然而，由于老年 HNSCC 患者在临床试验中代表性不足，目前针对该队列的临床决策在很大程度上缺乏临床证据。
2010 年至 2018 年期间，弗赖堡大学医学中心对 246 例接受（放）化疗的 HNSCC 老年患者（≥65 岁）进行了评估，评估内容包括明确诊断和辅助治疗的治疗模式、局部区域控制（LRC）、无进展生存期（PFS）和总生存期（OS）。根据 CTCAE v5.0 量化急性和晚期治疗相关毒性。
本分析共纳入 246 例患者，其中 166 例接受明确诊断治疗，80 例接受辅助治疗。OS、PFS 和 LRC 的两年生存率分别为 56.9%、44.9%和 75.5%。不同年龄组之间的生存率差异显著，65-74 岁和≥75 岁患者的 OS 分别为 40 和 22 个月，PFS 分别为 23 和 12 个月（p<0.05）。对于明确诊断治疗，与单纯放疗相比，65-74 岁患者接受同期化疗可显著提高 OS（p<0.05），而≥75 岁患者则无获益（p=0.904）。对于辅助放化疗，65-74 岁患者的 OS 率有改善趋势（p=0.151）。在多因素分析中，低表现状态（HR=2.584，95%CI 1.561-4.274；p<0.001）和吸烟（HR=1.960，95%CI 1.109-3.464，p<0.05）是 OS 降低的最强独立预后因素。138 例（56.1%）患者发生急性 3/4 级毒性，45 例（19.9%）患者发生慢性 3 级毒性。
对于老年 HNSCC 患者，放疗是一种可行的治疗方法。与高 LRC 相比，相对较低的 OS 可能反映了年龄和合并症。应慎重考虑老年 HNSCC 患者接受同期化疗。
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