Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.
Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA.
J Geriatr Oncol. 2021 Jan;12(1):122-127. doi: 10.1016/j.jgo.2020.06.023. Epub 2020 Jun 24.
Management of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire.
171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4-6 weeks, and at 2-3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as 'vulnerable', 11-14 as 'intermediate', and >14 as 'fit'. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes.
Median follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were 'vulnerable', 37% were 'intermediate', and 12% were 'fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001).
The G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.
老年人头颈部癌症（HNC）的管理是一种常见但具有挑战性的临床情况。我们利用老年-8 （G8）问卷评估立体定向体部放射治疗（SBRT）对生存率的影响。
171 例被认为不适合确定性治疗的 HNC 患者接受 SBRT ± 系统治疗。在基线、4-6 周和 2-3 个月后治疗时收集 G8 问卷。根据基线 G8 评分将患者分层：<11 为“脆弱”，11-14 为“中等”，>14 为“健康”。通过单变量 Kaplan-Meier 分析评估总生存率（OS）。重复测量方差分析用于确定基线特征是否影响 G8 评分变化。
中位随访时间为 17 个月。60%的患者出现复发性 HNC，30%的患者出现未经治疗的 HNC 原发性疾病，10%的患者出现转移性非 HNC 原发性疾病。中位年龄为 75 岁。中位 Charlson 合并症指数评分为 2。51%的患者为“脆弱”，37%为“中等”，12%为“健康”，中位生存期分别为 13.2、24.3 和 41.0 个月（p=0.004）。与稳定或增加随访 G8 评分的患者相比（n=102），随访 G8 评分下降（n=69）的患者的生存率显著降低，中位生存期分别为 8.6 和 36.0 个月（p<0.001）。
G8 问卷可能是一种有用的工具，可用于初始治疗决策，以预测预后并防止老年患者接受不适当的抗癌治疗。随访 G8 评分下降也可能预示着更差的生存，并有助于治疗后制定照护目标。
