Elderly patients affected by head and neck squamous cell carcinoma unfit for standard curative treatment: Is de-intensified, hypofractionated radiotherapy a feasible strategy?

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Pierluigi Bonomo, Isacco Desideri, Mauro Loi, Monica Lo Russo, Emanuela Olmetto, Virginia Maragna, Giulio Francolini, Camilla Delli Paoli, Roberta Grassi, Donato Pezzulla, Daniela Greto, Icro Meattini, Lorenzo Livi
ObjectivesThe aim of our work was to report on the clinical outcome of a moderately hyprofractionated radiotherapy regimen in elderly patients affected by head and neck squamous cell carcinoma (HNSCC).Material and methodsHNSCC aged ≥65 deemed unsuitable for curatively-intended concurrent chemo-radiotherapy or high-dose radiotherapy by clinical judgement were further evaluated with the Geriatric 8 (G8) questionnaire and Charlson comorbidity index (CCI). In case of a G8 score ≤14, a de-intensified radiation schedule of 40 Gy delivered in 16 fractions was prescribed.ResultsThirty-six patients were treated between 2011 and 2016. The median age of the cohort was 77.5 (range: 65–91 years) with a combined ECOG PS of 2–3 in 77.8% and CCI of ≥8 in 25% patients, respectively. At a median follow-up of 13 months (range 2–62 months), the 6-month and 1-year rates of loco-regional control and progression-free survival were 42%, 28% and 36% and 20%, respectively. At univariate analysis, log-rank test showed that age >75 years (p=0.036), worse PS (ECOG≥2; p=0.027), lower G8 score (<9; p=0.027) and PTV volume greater than 200 cc (p=0.038) had a significant correlation with PFS. The negative impact of the PTV volume on PFS was the only parameter confirmed in the multivariate analysis (HR 2.68; 95% CI: 1.24–5.81, p=0.013). No grade 4–5 toxicity was observed, while 13/36 patients (36%) had G3 acute side effects.ConclusionThe hypofractionated radiation schedule evaluated provides clinical benefit with low toxicity in frail, elderly patients affected by locally advanced HNSCC.



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