Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China; Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
Biomol Biomed. 2024 Sep 6;24(5):1417-1423. doi: 10.17305/bb.2024.10516.
Patients older than the expected age of the local population generally have limited life expectancy. The optimal treatment approach for very elderly patients with head and neck cancer remains uncertain. This study retrospectively analyzed patients over 78 years old, the expected age in 2019 for Chinese individuals, who underwent treatment for head and neck cancer at a tertiary cancer center in China. The study compared the overall survival rates among different treatment groups. The findings revealed that among patients eligible for surgery, radical resection yielded better outcomes compared to radiotherapy-based treatments, with a hazard ratio of 0.362 (95% CI 0.160-0.819, P = 0.015). Among patients who received radiotherapy, those who received a total dose exceeding 60 Gy had a significantly longer survival compared to those who received palliative doses, with median survival time of 31 months versus 14 months (P = 0.003). Among 78 patients who underwent conventional fractionated radiotherapy (CFRT), 15 patients (19.23%) experienced unscheduled treatment breaks with a median duration of 12 days. However, these treatment breaks did not appear to impact survival (P > 0.1). The study also suggested that altered fractionated radiotherapy, including hypofractionated radiotherapy (hypo-RT), could be a viable alternative to CFRT, offering similar survival outcomes with reduced treatment duration. In conclusion, eligible patients should be treated with curative intent, even if they are older than the expected age of the local population. When radiotherapy is indicated, altered fractionation, particularly hypo-RT, may be a favorable option to consider.
一般来说，年龄大于当地人群预期年龄的患者预期寿命有限。对于 78 岁以上的老年头颈部癌症患者，最佳治疗方法仍不确定。本研究回顾性分析了在中国一家三级癌症中心接受头颈部癌症治疗的年龄大于 2019 年中国预期年龄（78 岁）的患者。本研究比较了不同治疗组的总生存率。研究结果表明，在适合手术的患者中，根治性切除术的结果优于基于放疗的治疗，风险比为 0.362（95%CI 0.160-0.819，P = 0.015）。在接受放疗的患者中，总剂量超过 60 Gy 的患者的生存时间明显长于接受姑息性剂量的患者，中位生存时间为 31 个月与 14 个月（P = 0.003）。在 78 例接受常规分割放疗（CFRT）的患者中，有 15 例（19.23%）出现计划外治疗中断，中位持续时间为 12 天。然而，这些治疗中断似乎并未影响生存（P > 0.1）。该研究还表明，改变分割放疗，包括适形调强放疗（hypo-RT），可能是 CFRT 的可行替代方案，提供相似的生存结果，同时缩短治疗时间。总之，即使患者年龄大于当地人群的预期年龄，也应给予有治愈意图的治疗。当需要放疗时，改变分割，特别是 hypo-RT，可能是一个值得考虑的有利选择。
