Deantoni Chiara Lucrezia, Galli Andrea, Valsecchi Davide, Porcu Luca, Tranò Lucrezia, Giannini Laura, Dell'Oca Italo, Chiara Anna, Gioffrè Vittorio, Tresoldi Moreno, Di Muzio Nadia Gisella, Giordano Leone, Mirabile Aurora
Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy.
Cancers (Basel). 2025 Sep 15;17(18):3007. doi: 10.3390/cancers17183007.
Cisplatin (CDDP) concomitant to radiotherapy (RT) is one of the main treatments for locally advanced head and neck squamocellular carcinoma (LA HNSCC); nevertheless, elderly patients are underrepresented in trials and frequently receive less intensive and suboptimal treatments, which often are unimodal, even if it is well demonstrated how chemoradiotherapy (CRT) with CDDP is superior to RT alone. We aim to analyze clinical feasibility in terms of acute toxicity and treatment adherence in patients receiving concurrent high-dose CDDP and RT with curative or adjuvant intent, comparing elderly (≥65 years) with young (<65 years) patients.
This is a monocentric, observational, prospective study of consecutive LA HNSCC patients treated with high dose CDDP concomitant to RT, from January 2017 to June 2024. The primary aim is to compare the performance of elderly patients with young patients in terms treatment adherence and toxicity, while the secondary aim is to assess treatment efficacy in terms of OS and PFS endpoints. The LA HNSCC patients were selected only by treatment, so all patients who did not receive chemoradiation were excluded. No difference in terms of compliance and toxicity events >G1 in the elderly versus young population is the null hypothesis. Data were analyzed using MedCal statistical software 14.12. A < 0.05 was considered statistically significant.
A total of 170 patients were included in the study, according to the selection criteria stated. Only 7 elderly (12.3%) patients received a dose < 200 mg/m, whereas 163 patients (87.7%) received ≥ 200 mg/m and all elderly patients completed RT, indicating a high level of adherence and effective management of treatment protocols, in front of a comparable incidence of acute toxicity to young patients (-value: 0.84). OS and PFS were not statistically different between elderly and young patients ( = 0.20 and = 0.72, respectively).
Our findings suggest the feasibility of curative oncological treatment for elderly individuals with LA HNSCC, if they are well selected and adequately supported. Future studies should focus on validating and expanding these results to improve patient care and outcomes.
顺铂（CDDP）联合放射治疗（RT）是局部晚期头颈部鳞状细胞癌（LA HNSCC）的主要治疗方法之一；然而，老年患者在试验中的代表性不足，且经常接受强度较低和不理想的治疗，这些治疗通常是单一模式的，尽管有充分证据表明CDDP同步放化疗（CRT）优于单纯放疗。我们旨在分析接受高剂量CDDP与RT同步进行根治性或辅助性治疗的患者在急性毒性和治疗依从性方面的临床可行性，比较老年（≥65岁）和年轻（<65岁）患者。
这是一项单中心、观察性、前瞻性研究，对2017年1月至2024年6月期间接受高剂量CDDP联合RT治疗的连续LA HNSCC患者进行研究。主要目的是比较老年患者和年轻患者在治疗依从性和毒性方面的表现，次要目的是根据总生存期（OS）和无进展生存期（PFS）终点评估治疗效果。LA HNSCC患者仅根据治疗情况进行选择，因此所有未接受放化疗的患者均被排除。老年人群与年轻人群在依从性和>1级毒性事件方面无差异是无效假设。使用MedCal统计软件14.12对数据进行分析。P<0.05被认为具有统计学意义。
根据所述选择标准，共有170例患者纳入研究。只有7例老年（12.3%）患者接受的剂量<200mg/m²，而163例患者（87.7%）接受的剂量≥200mg/m²，所有老年患者均完成放疗，这表明在与年轻患者急性毒性发生率相当的情况下，治疗方案的依从性高且管理有效（P值：0.84）。老年患者和年轻患者的OS和PFS无统计学差异（分别为P = 0.20和P = 0.72）。
我们的研究结果表明，对于经过精心挑选和充分支持的LA HNSCC老年患者，根治性肿瘤治疗是可行的。未来的研究应侧重于验证和扩展这些结果，以改善患者护理和治疗结果。
