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Ishii R, Ohkoshi A, Katori Y. Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment. Auris Nasus Larynx 2024; 51:647-658. [PMID: 38631257 DOI: 10.1016/j.anl.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
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Le Blanc G, Richardson K, Mlynarek A, Hier MP, Sadeghi N, Kergoat MJ, Mascarella M. Loss of Independence in Older Adults With Operable Oral Cavity Cancer: A Retrospective Cohort Study. Otolaryngol Head Neck Surg 2024; 171:431-438. [PMID: 38643406 DOI: 10.1002/ohn.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 01/05/2024] [Accepted: 02/17/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE To ascertain the effect of curative-intent surgery on loss of independence (LOI) in patients with oral cavity squamous cell carcinoma (OCSCC). STUDY DESIGN Retrospective observational study of patients diagnosed from 2014 to 2021. SETTING Single tertiary care academic center. Patients having undergone curative-intent surgical treatment for OCSCC from 2014 to 2021 in the cancer registry. METHODS LOI as the primary outcome was measured based on a combination of decrease in activities of daily living (ADLs) and/or decline in mobility during treatment. Descriptive statistics were used to compare baseline demographics and multivariable logistic regression was used to assess the association between LOI and perioperative variables of interest. RESULTS Of the 180 patients included in this study, 139 (79%) were fully independent in ADLs/instrumental ADLs prior to surgery. The average age of the cohort was 74 with 49% males. Thirty-seven (21%) experienced a decline in mobility or increased care needs following surgery, and 18 (10%) experienced an independent decline in functional status. Increasing age, osseous flap reconstruction, high Charlson Comorbidity Index, and major postoperative adverse events were associated with LOI. Fifty-five percent of patients with LOI had recovered to baseline within 7 months from surgery. LOI was associated with poor treatment tolerance (odds ratio: 4.77, 95% confidence interval: 1.87-12.2) while adjusting for multiple confounders. CONCLUSION LOI is common in older adults undergoing curative-intent surgery for OCSCC and associated with poor treatment tolerance.
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Affiliation(s)
- Gabriella Le Blanc
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael P Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Marie-Jeanne Kergoat
- Division of Geriatric Medicine, Department of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Marco Mascarella
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Raab G, Yu Y, Sherman E, Wong R, Mell LK, Lee NY, Zakeri K. Nomogram to predict risk of early mortality following definitive or adjuvant radiation and systemic therapy for head and neck cancer. Clin Transl Radiat Oncol 2024; 45:100725. [PMID: 38304239 PMCID: PMC10832379 DOI: 10.1016/j.ctro.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose/Objectives We sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death. Methods We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. Results Among 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4-3.7 %) and 2.2 %, (95 % CI 1.9-2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3-8.2 %) in the definitive group and 4.4 % (95 % CI 3.6-5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). Conclusion Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.
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Affiliation(s)
- Gabriel Raab
- Weill Cornell Medical College, New York, NY, USA
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bussu F, Tagliaferri L, Corbisiero MF, Lotto C, Pellini R, Guarino P, Mercante G, Galuppi A, Cariti F, Almadori G, Longo F, Calabrese L, Galli J, Presutti L, Nicolai P, Molteni G. Management of nasal vestibule carcinomas: recommendations by the Oncological Committee of the Italian Society of Otorhinolaryngology - Head and Neck Surgery. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:13-20. [PMID: 38420717 PMCID: PMC10914357 DOI: 10.14639/0392-100x-n2786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/28/2023] [Indexed: 03/02/2024]
Abstract
Objective Squamous cell carcinoma of the nasal vestibule (NV SCC) is a head and neck malignancy for which there is no established consensus on most aspects of clinical management. The purpose of this document is to give updated recommendations that incorporate recent evidence on its clinical characteristics and the high efficacy of brachytherapy as primary treatment modality. Methods A working group consisting of the members of the Scientific Committee for Oncology and Reconstructive Surgery of the Italian Society of Otorhinolaryngology Head and Neck Surgery and radiation oncologists expert in brachytherapy was formed to achieve a consensus. Results Consensus was reached on a set of recommendations, proposing a refined anatomical definition of the nasal vestibule, a novel T staging system of the NV SCC, and brachytherapy as standard of care, with a new method for catheter implantation. Conclusions The Committee emphasises the critical role of an accurate classification in clinical practice and encourages further research to validate the novel staging system and further improve treatment strategies. Where appropriate, it is recommended that patients be referred to centres with specific experience in brachytherapy for NV SCC.
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Affiliation(s)
- Francesco Bussu
- Department of Medicine, Surgery and Pharmacy, Sassari University, Italy
- Otolaryngology Division, Sassari University Hospital, Sassaey, Italy
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Rome, Italy
| | | | - Cecilia Lotto
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Raul Pellini
- Head and Neck Department, IRCCS National Cancer Institute “Regina Elena” Rome, Italy
| | - Pierre Guarino
- Otorhinolaryngology Head and Neck Surgery Unit, “Santo Spirito” Hospital of Pescara, Pescara, Italy
| | - Giuseppe Mercante
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Otorhinolaryngology - Head and Neck Surgery, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Francesco Cariti
- Department of Otolaryngology Head and Neck Surgery, “Mons. Dimiccoli” Hospital, Barletta, Italy
| | - Giovanni Almadori
- Unit of Head and Neck Surgical Oncology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Longo
- Maxillofacial & ENT Surgery Unit, Department of Head and Neck Surgery and Oncology, Istituto Nazionale Tumori IRCCS Fondazione “G. Pascale”, Naples, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano, Italy
| | - Jacopo Galli
- Unit of Otolaryngology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Livio Presutti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology - Head & Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Gabriele Molteni
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Otolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
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Ozbek L, Lion P, Patel A, Hughes J, Shah K, Stimpson P. Laryngectomy in Elderly Patients: A Case Series and Review of the Literature. Cureus 2023; 15:e49294. [PMID: 38957195 PMCID: PMC11218606 DOI: 10.7759/cureus.49294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 07/04/2024] Open
Abstract
Background and objective Patients over the age of 75 years make up 20% of the head and neck cancer population, which is a relatively under-represented patient cohort in clinical literature. To our knowledge, there are no studies evaluating the outcomes of laryngectomy in patients aged over 75 years, which prompted us to present this unique series. Methods We reviewed departmental records at the University College Hospital, London over a 10-year period, and identified a total of 18 patients over the age of 75 years who underwent total laryngectomy for squamous cell carcinoma. We evaluated the demographic, clinical, and histopathologic features and outcomes for each patient. Results The age of the cohort ranged from 75 to 90 years, with a mean age of 79.8 years. All patients had a Charlson Comorbidity Index (CCI) score of 3 or more (due to age), with a mean of 4.7, and a maximum score of 8 for two patients. Length of inpatient stay varied significantly, ranging from 20 to 149 days, with a mean of 46 days. We identified 14 patients who underwent laryngectomy prior to September 2017, in whom the five-year survival was 21.4%. The three-year survival rate for all patients was 22.2%. In bivariate analysis, advanced age at surgery positively correlated with increased length of hospital admission and increased incidence of complications, although these results were not statistically significant (p<0.05). Conclusions Our study highlights the significance of the impact of age and comorbidities on postoperative outcomes and sheds light on the unique challenges faced by an ageing population. Careful consideration must be made in terms of appropriate patient selection, and clinicians must offer a robust and tailored approach to elderly care.
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Affiliation(s)
- Leyla Ozbek
- Otolaryngology, University College Hospital, London, GBR
| | - Peter Lion
- Otolaryngology, University College Hospital, London, GBR
| | - Ankit Patel
- Otolaryngology, University College Hospital, London, GBR
| | - Jonathan Hughes
- Head and Neck Surgery, University College Hospital, London, GBR
| | - Kuntal Shah
- Head and Neck Surgery, University College Hospital, London, GBR
| | - Paul Stimpson
- Head and Neck Surgery, University College Hospital, London, GBR
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Chen J, Ding J, Xu Y, Hong H, Lin X, Xu M, Yan L, Xu T, Fei Z, Chen C. Significance of chemotherapy for older patients with nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A propensity score matching analysis. J Geriatr Oncol 2023; 14:101648. [PMID: 37897887 DOI: 10.1016/j.jgo.2023.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/02/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION This study aimed to evaluate the survival and prognosis of older patients with nasopharyngeal carcinoma (NPC) who received intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy using propensity score matching (PSM). MATERIALS AND METHODS We enrolled 841 older patients with NPC aged 60 years and above without metastasis receiving IMRT alone or chemoradiotherapy from 2012 to 2019. The comorbidity was assessed by adult comorbidity evaluation (ACE-27). PSM (1:3 ratio) was conducted between the two treatment groups based on four clinical factors including age, T-stage, N-stage, and ACE-27. Differences in overall survival (OS) and cancer-specific survival (CSS) were analyzed by the Kaplan-Meier method and Cox proportional hazard model. RESULTS A total of 841 patients with NPC were included in the study, there were 94 patients in the IMRT alone group and 747 patients in the chemoradiotherapy (CRT) group. After a 1:3 ratio PSM, 89 patients underwent IMRT alone and 223 patients underwent CRT. The baseline analysis showed an insignificant difference after PSM (P > 0.05). In multivariate analysis, we found that ACE-27 (≥2) was associated with worse five-year OS and CSS (HR = 1.994, 95%CI: 1.276-3.116, P = 0.002; HR = 1.849, 95%CI: 1164-2.935, P = 0.009, respectively). Chemotherapy was an independent prognosticator of better five-year OS and CSS (HR = 0.333, 95%CI: 0.213-0.552, P < 0.001; HR = 0.327, 95%CI: 0.204-0.524, P < 0.001, respectively). In terms of subgroup analysis, chemotherapy was a statistically beneficial predictor for stage III-IV patients (P < 0.05), but no significant difference in stage II patients (P > 0.05). About the adverse events, the incidence of hepatotoxicity (P = 0.002), neutropenia (P < 0.001), anemia (P < 0.001), and thrombocytopenia (P < 0.001) were significantly higher in the CRT group. DISCUSSION Combined modality therapy was associated with improved five-year OS and CSS in older adults with stage III-IV NPC, but was not associated with improved survival over IMRT alone in patients with stage II disease. Risk factors including T3-4 disease, positive lymph nodes, ACE-27 score ≥ 2, and IMRT alone were were associated with worse OS and CSS. There was a significantly higher incidence of hepatotoxicity and blood toxicity in the CRT group.
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Affiliation(s)
- Jiawei Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Jianming Ding
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Yiying Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Huiling Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Xiaoting Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Mengting Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Linghui Yan
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Ting Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Zhaodong Fei
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
| | - Chuanben Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
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Sexton GP, Walsh P, Moriarty F, O'Neill JP. Age Alone Is Not a Barrier to Concurrent Chemoradiotherapy for Advanced Head and Neck Cancer. Ann Otol Rhinol Laryngol 2023; 132:275-283. [PMID: 35450431 DOI: 10.1177/00034894221086087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Head and Neck Cancer (HNC) is associated with significant morbidity and mortality, especially when high stage disease is present. There exists a range of options for the management of locoregionally advanced HNC, though doubt remains as to the optimal strategy in the elderly population. AIMS To evaluate the benefits imparted by concurrent chemoradiotherapy (CCRT) to the elderly population of HNC patients in Ireland. METHODS A retrospective cohort study was conducted using 20 years of cancer registry data provided by the National Cancer Registry of Ireland. Cox multivariate regression analysis was applied to test for the benefits of CCRT in HNC. RESULTS Survival analysis showed an overall benefit to the use of CCRT in patients with advanced disease over 70 years, particularly when used for hypopharyngeal, oropharyngeal, and laryngeal malignancy. There was a benefit to cancer-specific but not all-cause mortality in those over 75 years, and no benefit was observed to the addition of chemotherapy in those over 80 years; only 8 patients over 80 received CCRT. There was no statistically significant difference in the benefits derived by those over 70 years relative to those under 70 years. CONCLUSION CCRT confers significant survival benefits to appropriately selected elderly HNC patients and should therefore not be withheld solely on the basis of age.
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Affiliation(s)
- Gerard P Sexton
- Department of Otolaryngology, Head & Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Frank Moriarty
- Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology, Head & Neck Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Restifo D, Raab G, McBride SM, Pfister DG, Wong RJ, Lee NY, Shahrokni A, Zakeri K. Correlation of an Electronic Geriatric Assessment With Receipt of Adjuvant Radiation and Chemotherapy in Older Adults With Head and Neck Cancer. Adv Radiat Oncol 2022; 8:101096. [PMID: 36483055 PMCID: PMC9723299 DOI: 10.1016/j.adro.2022.101096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/25/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Treatment patterns for head and neck squamous cell carcinoma (HNSCC) vary among older adults because of concerns about their health status. Geriatric assessment may guide treatment for older adults with HNSCC by assessing their health status. Methods and Materials We conducted a retrospective review of adjuvant treatment received by older patients with HNSCC who completed a novel geriatric assessment, the electronic Rapid Fitness Assessment, before treatment. The electronic Rapid Fitness Assessment yields an accumulated geriatric deficits (AGD) score. Higher AGD score indicates greater frailty. Comparators were age and performance status. The Wilcoxon rank sum test compared differences between those who did and did not receive adjuvant radiation therapy and chemotherapy. Results The cohort included 73 patients, of whom 56 (77%) had oral cavity cancer. The most common geriatric deficits were major distress, social activity limitation, depression, and impaired activities of daily living. AGD score, age, and performance status were not associated with receipt of adjuvant radiation. Patients who received adjuvant chemotherapy had a significantly lower median AGD score than those who did not (3 vs 6; P = .044), but there was no association with age and performance status. Of the 17 patients with newly diagnosed disease and either positive margins or extranodal extension, only 9 received adjuvant radiation and only 3 received systemic therapy. Most often, systemic therapy was omitted because of patient preference or comorbidities and poor performance status. There was a nonstatistically significant lower AGD score between patients who did and did not receive standard fractionated radiation therapy (median, 4 vs 6.5; P = .13). Conclusions Receipt of adjuvant chemotherapy was associated with frailty. Rates of chemotherapy utilization were very low, indicating the need for novel strategies to mitigate the toxicity burden in this patient population. Receipt of adjuvant radiation therapy was not associated with frailty; however, there was a trend toward lower frailty among those who did receive radiation therapy.
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Affiliation(s)
| | - Gabriel Raab
- Weill Cornell Medical College, New York, New York
| | | | | | - Richard J. Wong
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Departments of Radiation Oncology,Corresponding author: Kaveh Zakeri, MD, MAS
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Ishii R, Ohkoshi A, Kiyota N, Matsuura K, Yasuda K, Imamura Y, Saito Y, Homma A. Management of elderly patients with head and neck cancer. Jpn J Clin Oncol 2022; 52:313-321. [PMID: 35165732 DOI: 10.1093/jjco/hyac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
There are no established guidelines for managing older patients with head and neck cancer. Most clinical trials that define current standard therapy included few elderly patients. On the other hand, there is great variability in patients' comorbidities, physical functions, cognitive function, familial and financial background and values. The key point appears to be appropriate geriatric assessment, clarifying the patients' outcomes and a multidisciplinary team approach, including the treatment decision-making policy. Although these processes should be scientific in nature, the evidence for the treatment of elderly head and neck patients is very limited. This review summarizes the evidence available regarding the management of geriatric assessment, each treatment modality and the multidisciplinary team approach for older patients with head and neck cancers.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan
| | - Yuki Saito
- Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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Buglione M, Alterio D, Maddalo M, Greco D, Gerardi MA, Tomasini D, Pegurri L, Augugliaro M, Marvaso G, Turturici I, Guerini A, Ansarin M, Spiazzi L, Costa L, Cossu Rocca M, Magrini SM, Jereczek-Fossa BA. Three weekly versus weekly concurrent cisplatin: safety propensity score analysis on 166 head and neck cancer patients. Radiat Oncol 2021; 16:239. [PMID: 34930353 PMCID: PMC8686550 DOI: 10.1186/s13014-021-01966-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Radio-chemotherapy with CDDP is the standard for H&N squamous cell cancer. CDDP 100 mg/m2/q3 is the standard; alternative schedules are used to reduce toxicity, mostly 40 mg/m2/q1.
Methods Patients were treated from 1/2010 to 1/2017 in two Radiation Oncology Centres. Propensity score analysis (PS) was retrospectively used to compare these two schedules. Results Patients analyzed were 166. Most (114/166) had 1w-CDDP while 52 had 3w-CDDP. In the 3w-CDDP group, patients were younger, with better performance status, smaller disease extent and a more common nodal involvement than in the 1w-CDDP. Acute toxicity was similar in the groups. Treatment compliance was lower in the w-CCDP. Overall survival before PS was better for female, for oropharyngeal disease and for 3w-CDDP group. After PS, survival was not related to the CDDP schedule. Conclusions 3w-CDDP remains the standard for fit patients, weekly schedule could be safely used in selected patients.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Daniela Alterio
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Marta Maddalo
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Diana Greco
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Marianna Alessandra Gerardi
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Davide Tomasini
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Ludovica Pegurri
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Matteo Augugliaro
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Irene Turturici
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Andrea Guerini
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Luigi Spiazzi
- Medical Physics, ASST Spedali Civili, Brescia, Italy
| | - Loredana Costa
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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11
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Malik NH, Kim MS, Chen H, Poon I, Husain Z, Eskander A, Boldt G, Louie AV, Karam I. Stereotactic Radiation Therapy for De Novo Head and Neck Cancers: A Systematic Review and Meta-Analysis. Adv Radiat Oncol 2020; 6:100628. [PMID: 33665492 PMCID: PMC7897759 DOI: 10.1016/j.adro.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Stereotactic body radiation therapy (SBRT) for de novo (previously untreated) head and neck cancers (HNCs) is increasingly being used in medically unfit patients. A systematic review of SBRT was conducted for previously untreated HNCs. Methods and Materials Medline (PubMed), excerpta medica database, and Cochrane Library databases were queried from inception until July 2020. Comparative outcome data were extracted where available up to 5 years. Results from random-effect models were presented in forest plots, with between-study heterogeneity evaluated by I2 statistics and Q-tests. Results Nine studies met inclusion criteria, representing 157 patients. Local control rates at 1, 2, and 3 years were as follows: 90.7% (95% confidence interval, 80.6%-95.6%), 81.8% (67.2%-90.7%), and 73.5% (40.4%-90.5%), respectively. Overall survival at 1, 2, and 3 years was 75.9% (75.1%-76.6%), 61.1% (60.3%-61.9%), and 50.0% (48.8%-51.4%), respectively. Late grade 3 to 4 toxicity rate was 3.3% (0.2%-10.2%), and late grade 5 toxicity rate was 0.1% (0.0%-1.0%). Conclusions SBRT for de novo HNC is safe and effective in providing locoregional control, with acceptable toxicities in most subsites. This finding warrants broader validation to guide its scope.
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Affiliation(s)
- Nauman H. Malik
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Michael S. Kim
- Department of Radiation Oncology, Nova Scotia Cancer Centre, Dalhousie University, Halifax, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Corresponding author: Irene Karam, MD
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12
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Lyu Y, Ni M, Zhai R, Kong F, Du C, Hu C, Ying H. Clinical characteristics and prognosis of elderly nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Eur Arch Otorhinolaryngol 2020; 278:2549-2557. [PMID: 33021689 PMCID: PMC8165069 DOI: 10.1007/s00405-020-06399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
Purpose To evaluate the clinical characteristics and prognosis of elderly nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT). Methods From June 2008 to October 2014, 148 newly diagnosed non-metastatic elderly NPC patients (aged ≥ 70 years) receiving IMRT were recruited. Comorbid condition was evaluated using the age-adjusted Charlson Comorbidity Index (ACCI). Kaplan–Meier method was used to estimate survival rates and the differences were compared using log-rank test. Hazard ratio (HR) and the associated 95% confidence interval (CI) were calculated using Cox proportional hazard model by means of multivariate analysis. Results The median follow-up time was 66.35 months. Estimated OS rate at 5 years for the entire group was 61.8% (95% confidence interval [CI] 0.542–0.703). The 5-year OS rate of RT alone group was 58.4% (95% [CI] 0.490–0.696) compared with 65.2% (95% [CI] 0.534–0.796) in CRT group (p = 0.45). In patients receiving IMRT only, ACCI score equal to 3 was correlated with superior 5-year OS rate in comparison with higher ACCI score 62.1% (95% [CI] 0.510–0.766) to 48.5% (95% [CI] 0.341–0.689), respectively; p = 0.024). A 5-year OS rate of 63.1% (95% [CI] 0.537–0.741) was observed in patients younger than 75 years old compared with 57.5% (95% [CI] 0.457–0.723) in patients older (p = 0.026). Patients with early-stage disease (I–II) showed better prognosis than patients with advanced-stage (III–IV) disease (5-year OS, 72.3–55.4%, respectively; p = 0.0073). The Cox proportional hazards model suggested that age independently predicted poorer OS (HR, 1.07; 95%CI 1.00–1.15, p = 0.04). Conclusion The survival outcome of patients aged ≥ 70 years receiving IMRT only was similar to chemoradiotherapy with significantly less acute toxicities. Among the population, age is significantly prognostic for survival outcomes.
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Affiliation(s)
- Yingchen Lyu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mengshan Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruiping Zhai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangfang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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13
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Gogineni E, Rana Z, Vempati P, Karten J, Sharma A, Taylor P, Pereira L, Frank D, Paul D, Seetharamu N, Ghaly M. Stereotactic body radiotherapy as primary treatment for elderly and medically inoperable patients with head and neck cancer. Head Neck 2020; 42:2880-2886. [PMID: 32691496 DOI: 10.1002/hed.26342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/23/2020] [Accepted: 05/30/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) who are not candidates for definitive treatment represent an increasing challenge, with limited data to guide management. Conventional local therapies such as surgery and chemoradiation can significantly impact quality of life (QoL). There has been limited data published using stereotactic body radiotherapy (SBRT) as primary treatment in previously unirradiated patients. We hypothesize that SBRT provides high rates of control while limiting toxicity. METHODS A total of 66 medically unfit previously unirradiated patients with HNC were treated with SBRT, consisting of 35-40 Gy to gross tumor volume and 30 Gy to clinical target volume in five fractions. RESULTS Median age was 80 years. Local control (LC) and overall survival (OS) at 1 year were 73% and 64%. Two patients experienced grade 3 toxicity. CONCLUSION SBRT shows acceptable outcomes with relatively low toxicity in previously unirradiated patients with HNC who are medically unfit for conventional treatment. SBRT may provide an aggressive local therapy with high rates of LC and OS while maintaining QoL.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Prashant Vempati
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Jessie Karten
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Anurag Sharma
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Peter Taylor
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
| | - Lucio Pereira
- Department of Otolaryngology, Northwell Health, Lake Success, New York, USA
| | - Douglas Frank
- Department of Otolaryngology, Northwell Health, Lake Success, New York, USA
| | - Doru Paul
- Department of Medical Oncology, Northwell Health, Lake Success, New York, USA
| | | | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, New York, USA
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14
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Gogineni E, Rana Z, Wotman M, Karten J, Riegel A, Marrero M, Maduro L, Kamdar D, Frank D, Paul D, Seetharamu N, Ghaly M. Impact of stereotactic body radiation therapy on geriatric assessment and management for older patients with head and neck cancer using G8. J Geriatr Oncol 2020; 12:122-127. [PMID: 32593669 DOI: 10.1016/j.jgo.2020.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 06/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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). CONCLUSION 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.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Michael Wotman
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Jessie Karten
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Adam Riegel
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Luis Maduro
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA
| | - Dev Kamdar
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Douglas Frank
- Department of Otolarygology, Head / Neck Surgery, Northwell Health, Lake Success, NY, USA
| | - Doru Paul
- Department of Medical Oncology, Northwell Health, Lake Success, NY, USA
| | | | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Lake Success, NY, USA.
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15
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Coca‐Pelaz A, Halmos GB, Strojan P, Bree R, Bossi P, Bradford CR, Rinaldo A, Vander Poorten V, Sanabria A, Takes RP, Ferlito A. The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review. Head Neck 2019; 41:2410-2429. [DOI: 10.1002/hed.25696] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrés Coca‐Pelaz
- Department of OtolaryngologyHospital Universitario Central de Asturias Oviedo Spain
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Primož Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Remco Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical SpecialtiesRadiological Sciencesand Public HealthUniversity of Brescia, ASST‐Spedali Civili Brescia Italy
| | - Carol R. Bradford
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Michigan Ann Arbor Michigan
| | | | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery and Department of Oncology, Section Head and Neck OncologyUniversity Hospitals Leuven, KU Leuven Leuven Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of MedicineUniversidad de Antioquia, Clínica Vida Medellín Colombia
| | - Robert P. Takes
- Department of Otolaryngology – Head and Neck SurgeryRadboud University Medical Center Nijmegen The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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16
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Rodrigo JP, García‐Velasco F, Ambrosch P, Vander Poorten V, Suárez C, Coca‐Pelaz A, Strojan P, Hutcheson K, Folz BJ, Bernal‐Sprekelsen M, Rinaldo A, Silver CE, Ferlito A. Transoral laser microsurgery for glottic cancer in the elderly: Efficacy and safety. Head Neck 2019; 41:1816-1823. [DOI: 10.1002/hed.25616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/25/2018] [Accepted: 12/11/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Fabian García‐Velasco
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Petra Ambrosch
- Department of Otorhinolaryngology, Head and Neck SurgeryChristian‐Albrechts‐University of Kiel Kiel Germany
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck SurgeryUniversity Hospitals Leuven Leuven Belgium
- Department of Oncology, Section Head and Neck OncologyKU Leuven Leuven Belgium
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Andrés Coca‐Pelaz
- Department of Otolaryngology, Hospital Universitario Central de AsturiasUniversity of Oviedo, ISPA, IUOPA, CIBERONC Oviedo Spain
| | - Primoz Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Kate Hutcheson
- Department of Head and Neck Surgery, Section of Speech Pathology and AudiologyMD Anderson Cancer Center Houston Texas
| | | | | | - Alessandra Rinaldo
- Otorhinolaryngology‐Head and neck surgery, University of Udine School of Medicine Udine Italy
| | - Carl E. Silver
- Department of SurgeryUniversity of Arizona College of Medicine Phoenix Arizona
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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17
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Cushman TR, Haque W, Menon H, Rusthoven CG, Butler EB, Teh BS, Verma V. Postoperative chemoradiotherapy versus radiotherapy alone for elderly cervical cancer patients with positive margins, lymph nodes, or parametrial invasion. J Gynecol Oncol 2018; 29:e97. [PMID: 30207105 PMCID: PMC6189436 DOI: 10.3802/jgo.2018.29.e97] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 12/17/2022] Open
Abstract
Objective Women with cervical cancer (CC) found to have positive surgical margins, positive lymph nodes, and/or parametrial invasion receive a survival benefit from postoperative chemoradiotherapy (CRT) vs. radiation therapy (RT) alone. However, older women may not benefit to the same extent, as they are at increased risk of death from non-oncologic causes as well as toxicities from oncologic treatments. This study sought to evaluate whether there was a survival benefit of CRT over RT in elderly patients with cervical cancer. Methods The National Cancer Database was queried for patients ≥70 years old with newly diagnosed IA2, IB, or IIA CC and positive margins, parametrial invasion, and/or positive nodes on surgical resection. Statistics included logistic regression, Kaplan-Meier overall survival (OS), and Cox proportional hazards modeling analyses. Results Altogether, 166 patients met inclusion criteria; 62 (37%) underwent postoperative RT and 104 (63%) underwent postoperative CRT. Younger patients and those living in areas of higher income were less likely to receive CRT, while parametrial invasion and nodal involvement were associated with an increased likelihood (p<0.05 for all). There were no OS differences by treatment type. Subgroup analysis by number of risk factors, as well as each of the 3 risk factors separately, also did not reveal any OS differences between cohorts. Conclusion In the largest such study to date, older women with postoperative risk factor(s) receiving RT alone experienced similar survival as those undergoing CRT. Although causation is not implied, careful patient selection is paramount to balance treatment-related toxicity risks with theoretical outcome benefits.
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Affiliation(s)
- Taylor R Cushman
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Hari Menon
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, CO, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.
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18
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Verma V, Surkar SM, Moreno AC, Lin C, Simone CB. Practice patterns and outcomes of chemoradiotherapy versus radiotherapy alone for older patients with nasopharyngeal cancer. Cancer Med 2018; 7:1604-1611. [PMID: 29603669 PMCID: PMC5943491 DOI: 10.1002/cam4.1290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 01/23/2023] Open
Abstract
Older patients are at increased risk of toxicities from aggressive oncologic therapy and of nononcologic death. A meta‐analysis of non‐nasopharyngeal head and neck cancers showed no statistical benefit in adding chemotherapy to radiotherapy (RT) in older patients; another meta‐analysis of RT versus chemoradiotherapy (CRT) in NPC found advantages to CRT, but vastly under‐represented patients ≥70 years old. This is the largest study to date evaluating outcomes of CRT versus RT alone in this population. The National Cancer Data Base (NCDB) was queried for primary nasopharyngeal cancer cases (2004–2013) in patients ≥70 years old receiving RT alone or CRT. Patients with unknown RT/chemotherapy and T1N0 or M1 disease were excluded. Logistic regression analysis ascertained factors associated with CRT delivery. Kaplan–Meier analysis evaluated overall survival (OS) between both cohorts. Cox proportional hazards modeling determined variables associated with OS. In total, 930 patients were analyzed (n = 713 (77%) CRT, n = 217 (23%) RT). Groups were relatively balanced; CRT was less frequently delivered in patients with advancing age, lower nodal burden, and females (P < 0.05 for all). Median OS in the CRT and RT groups were 35.3 versus 20.0 months, respectively (P = 0.002). On multivariate analysis, independent predictors of OS included age, comorbidities, income and insurance status, tumor grade, and stage (P < 0.05 for all). Notably, receipt of chemotherapy independently predicted for improved OS (P = 0.036). CRT, compared to RT alone, was independently associated with improved survival in NPC patients ≥70 years old. CRT appears to be a promising approach in this population, but treatment‐related toxicity risks should continue to be weighed against potential oncologic benefits.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Swati M Surkar
- Department of Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Amy C Moreno
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland
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19
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Outcomes of Craniofacial Open Surgery in Octogenarians. J Neurol Surg B Skull Base 2018; 79:515-521. [PMID: 30456018 DOI: 10.1055/s-0038-1635077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/13/2018] [Indexed: 10/17/2022] Open
Abstract
Introduction The steady increase in average life expectancy has led to a rise in the number of referrals of elderly patients for major operations. It is not clear whether age itself is a risk factor for morbidity and mortality after skull base operations. We investigated a possible link among a cohort of patients older than 80 years of age who underwent those surgeries in our department. Methods We conducted a retrospective analysis of all patients who underwent skull base surgery at the TASMC (Tel Aviv Sourasky Medical Center) between 2000 and 2016. Results A total of 369 patients underwent open skull base surgeries in our institution, and 13 were patients older than 80 years. The median age of the octogenarians was 83.4 (range 80-89), and the male-to-female ratio was 7:6. Twelve patients had major systemic comorbidities. Four patients had major complications associated with surgery: three had early wound complications, and one each had early central nervous system complications, early and late systemic complications, and late orbital complications. This complication rate is comparable to that of our younger group of 356 patients. The overall survival rate was measured for 30 days, 1 year, and 3 years, and it was not significantly different between the octogenarians and that of the younger patients. Further comparison of the elderly group with 13 matched younger patients revealed no difference of morbidity and mortality between the two groups. Conclusions Despite their systemic comorbidities, the morbidity and mortality rates associated with skull base surgery in octogenarians appear to be comparable to that of younger patients undergoing the same procedures.
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20
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Baxter MF, Newman R, Longpré SM, Polo KM. Occupational Therapy's Role in Cancer Survivorship as a Chronic Condition. Am J Occup Ther 2017; 71:7103090010P1-7103090010P7. [PMID: 28422624 DOI: 10.5014/ajot.2017.713001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Improved medical care has resulted in a documented increase in cancer survivors in the United States. Cancer survivors face challenges in participation across all facets of life as a result of the cancer and subsequent cancer treatments. Long-term and late-term sequelae can result in impairments in neurological systems, decreased stamina, loss of range of motion, and changes in sensation and cognition. These impairments are often long lasting, which categorizes cancer survivorship as a chronic condition. This categorization presents treatment challenges, especially in creating rehabilitation and habilitation service options that support cancer survivors. Occupational therapy provides a unique focus that can benefit cancer survivors as they face limitations in participation in all aspects of daily living. Research, advocacy, and education efforts are needed to focus on the specific rehabilitation and habilitation needs of cancer survivors to increase access to occupational therapy's distinct value.
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Affiliation(s)
- Mary Frances Baxter
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Robin Newman
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Sheila M Longpré
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Katie M Polo
- Mary Frances Baxter, PhD, FAOTA, is Professor, School of Occupational Therapy, Texas Woman's University, Houston;
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21
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Pollom EL, Chin AL, Lee NY, Tsai CJ. Patterns of Care in Adjuvant Therapy for Resected Oral Cavity Squamous Cell Cancer in Elderly Patients. Int J Radiat Oncol Biol Phys 2017; 98:758-766. [PMID: 28366574 DOI: 10.1016/j.ijrobp.2017.01.224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To characterize the patterns of care and potential barriers to access to care for elderly patients with oral cavity cancer in the adjuvant setting. METHODS AND MATERIALS We performed a retrospective cohort study using the National Cancer Data Base and identified patients with resected oral cavity squamous cell carcinoma diagnosed between 2004 and 2012, who survived for ≥3 months after surgery. We used logistic regression models to assess the association between age (<70, 70-79, and ≥80 years) and the receipt of adjuvant therapy within 3 months of surgery. We additionally assessed the association between patient and tumor characteristics and the receipt of adjuvant therapy among those aged ≥70 years. RESULTS A total of 25,829 patients were included in the study. Compared with those aged <70 years, older patients were more likely to have no neck dissection or have fewer lymph nodes dissected and were less likely to receive adjuvant therapy than younger patients. Among our cohort, 11,361 patients (44%) had pathologic T3-T4 disease or N2-N3 disease, and 4185 patients (16%) had extracapsular nodal extension or positive surgical margins. In multivariate analyses controlling for comorbidity and demographic characteristics, older age was independently associated with lower odds of receiving adjuvant radiation therapy in the subgroup with T3 or T4 disease or N2 or N3 disease and adjuvant chemoradiation therapy in the positive extracapsular nodal extension or positive surgical margin subgroup. Among elderly patients, both greater patient distance from reporting facility and older age were associated with lower odds of receiving both adjuvant radiation therapy (odds ratio 0.66; 95% confidence interval, 0.55-0.81) and chemoradiation therapy (odds ratio 0.56; 95% confidence interval, 0.40-0.79). CONCLUSIONS In a national hospital-based cohort of patients with oral cavity cancer, elderly patients were less likely to receive adjuvant radiation or chemoradiation therapy. Greater patient distance from reporting facility, in addition to older age, was associated with lower odds of receiving both adjuvant radiation therapy and adjuvant chemoradiation therapy.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Tsai MS, Lai CH, Lee CP, Yang YH, Chen PC, Kang CJ, Chang GH, Tsai YT, Lu CH, Chien CY, Young CK, Fang KH, Liu CJ, Yeh RMA, Chen WC. Mortality in tongue cancer patients treated by curative surgery: a retrospective cohort study from CGRD. PeerJ 2016; 4:e2794. [PMID: 27994985 PMCID: PMC5162395 DOI: 10.7717/peerj.2794] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 11/14/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Our study aimed to compare the outcomes of surgical treatment of tongue cancer patients in three different age groups. METHODS From 2004 to 2013, we retrospectively analyzed the clinical data of 1,712 patients who were treated in the four institutions constituting the Chang Gung Memorial Hospitals (CGMH). We divided and studied the patients in three age groups: Group 1, younger (<65 years); Group 2, young old (65 to <75); and Group 3, older old patients (≥75 years). RESULTS Multivariate analyses determined the unfavorable, independent prognostic factors of overall survival to be male sex, older age, advanced stage, advanced T, N classifications, and surgery plus chemotherapy. No significant differences were found in adjusted hazard ratios (HR) of death in early-stage disease (stage I-II) among Group 1 (HR 1.0), Group 2 (HR 1.43, 95% confidence interval (CI) [0.87-2.34], p = 0.158), and Group 3 (HR 1.22, 95% CI [0.49-3.03], p = 0.664) patients. However, amongst advanced-stage patients (stage (III-IV)), Group 3 (HR 2.53, 95% CI [1.46-4.38], p = 0.001) showed significantly worse survival than the other two groups after other variables were adjusted for. Fourteen out of 21 older old, advanced-staged patients finally died, and most of the mortalities were non-cancerogenic (9/14, 64.3%), and mostly occurred within one year (12/14, 85%) after cancer diagnosis. These non-cancer cause of death included underlying diseases in combination with infection, pneumonia, poor nutrition status, and trauma. CONCLUSIONS Our study showed that advanced T classification (T3-4), positive nodal metastasis (N1-3) and poorly differentiated tumor predicted poor survival for all patients. Outcome of early-stage patients (stage I-II) among three age groups were not significantly different. However, for advanced-stage patients (stage III-IV), the older old patients (≥75) had significantly worse survival than the other two patient groups. Therefore, for early-stage patients, age should not deny them to receive optimal treatments. However, older old patients (≥75) with advanced cancer should be comprehensively assessed by geriatric tools before surgical treatment and combined with intensive postoperative care to improve outcome, especially the unfavorable non-cancerogenic mortalities within one year after cancer diagnosis.
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Affiliation(s)
- Ming-Shao Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chia-Hsuan Lai
- Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Geng-He Chang
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Yao-Te Tsai
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chang-Hsien Lu
- Department of Medical Oncology, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital , Kaohsiung , Taiwan
| | - Chi-Kuang Young
- Department of Otolaryngology -Head and Neck Surgery, Keelung Chang Gung Memorial Hospital , Keelung , Taiwan
| | - Ku-Hao Fang
- Department of Otolaryngology -Head and Neck Surgery, Linkou Chang Gung Memorial Hospital , Taoyuan , Taiwan
| | - Chin-Jui Liu
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Re-Ming A Yeh
- Department of Otolaryngology-Head and Neck Surgery, Chiayi Chang Gung Memorial Hospital , Chiayi , Taiwan
| | - Wen-Cheng Chen
- Center of Excellence for Chang Gung Research Datalink, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Maruyama T, Nakasone T, Matayoshi A, Arasaki A. Successful tongue cancer surgery under general anesthesia in a 99-year-old patient in Okinawa, Japan: A case report and review of the literature. Oncol Lett 2016; 12:1675-1678. [PMID: 27588116 PMCID: PMC4998137 DOI: 10.3892/ol.2016.4864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/15/2016] [Indexed: 11/14/2022] Open
Abstract
As advances in the medical field have resulted in increased life expectancy, performing surgery under general anesthesia in elderly patients has become an important issue. A 99-year-old Okinawan female was admitted to the hospital presenting with pain in the tongue. Following physical examination, a clinical diagnosis of early stage tongue cancer (T2N0Mx) was confirmed. Early stage tongue cancer is particularly easy to access for surgical resection. By contrast, later stages of tongue cancer are associated with pain, dysphagia and throat obstruction. The patient and their family agreed to surgery due to the worsening pain associated with the tumor and gave informed consent for surgery. Following consultation with a cardiologist and an anesthesiologist, the tongue tumor was surgically resected under general anesthesia. Subsequent to surgery, the patient experienced pain relief and was discharged from the hospital on day 14 post-surgery. The patient was able to maintain the same quality of life, and lived for 5 years and 2 months longer without evidence of disease, surviving to the age of 104 years old. The present case demonstrates that surgery under general anesthesia may be appropriate in patients of an advanced age, with a treatment plan that should ideally be based on careful assessment of the wishes of the patient and their family, medical risks, and benefits and economic costs of alternative treatments, in addition to consideration of the patient's culture.
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Affiliation(s)
- Tessho Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan; Department of Clinical Neuroscience, Oral and Maxillofacial Functional Rehabilitation, University of the Ryukyus Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Clinical Neuroscience, Oral and Maxillofacial Functional Rehabilitation, University of the Ryukyus Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Clinical Neuroscience, Oral and Maxillofacial Functional Rehabilitation, University of the Ryukyus Hospital, Nishihara, Okinawa 903-0215, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan; Department of Clinical Neuroscience, Oral and Maxillofacial Functional Rehabilitation, University of the Ryukyus Hospital, Nishihara, Okinawa 903-0215, Japan
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Xiao H, Tan F, Goovaerts P, Adunlin G, Ali AA, Gwede CK, Huang Y. Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida. Am J Mens Health 2016; 10:285-95. [PMID: 25542838 PMCID: PMC4483149 DOI: 10.1177/1557988314564593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.
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Affiliation(s)
- Hong Xiao
- Florida A&M University, Tallahassee, FL, USA
| | - Fei Tan
- Indiana University-Purdue University Indianapolis, IN, USA
| | | | | | | | | | - Youjie Huang
- Centers for Disease Control and Prevention Foundation, Atlanta, GA
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25
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Brown ML, Glanzmann C, Huber G, Bredell M, Rordorf T, Studer G. IMRT/VMAT for malignancies in the head-and-neck region : Outcome in patients aged 80. Strahlenther Onkol 2016; 192:526-36. [PMID: 27306747 PMCID: PMC4956718 DOI: 10.1007/s00066-016-0986-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/21/2016] [Indexed: 11/24/2022]
Abstract
Objective Elderly patients with malignant head-and-neck tumors (HNT) often pose a therapeutic challenge. They frequently have significant comorbidities which may influence their ability to tolerate tumor-specific therapies. Our aim was to investigate the outcome of patients aged 80+ years undergoing curative intent intensity- or volume-modulated radiation therapy (IMRT/VMAT). Methods We retrospectively reviewed our HNT patients aged 80+ treated with curative IMRT/VMAT from December 2003 to November 2015. Overall survival (OS), disease-free survival (DFS), local control (LC), and treatment tolerance were assessed. Outcome results were compared with that of a younger HNT patient cohort from our hospital. Results A total of 140 consecutive patients were included (65 postoperative, 75 definitive). Mean/median age at treatment start was 84.8/84.1 years (range 80–96 years). Mean/median follow-up time was 25/16 months (range 2–92 months). Of the 140 patients, 80 were alive with no evidence of disease when last seen, 28 had died due to the cancer, 12 remained alive with disease, the remaining 20 died intercurrently. Systemic concomitant therapy was administered in 7 %. Late grade 3–4 toxicity was observed in 2 %. All patients completed treatment. Hospitalization and feeding tube rates were 26 % and 11 %, respectively. The 2‑/3-year LC, DFS, and OS rates for the entire cohort were 81/80 %, 69/63 %, and 68/66 %, respectively. Squamous cell carcinoma (SCC) patients showed an inferior 3-year OS rate as compared to non-SCC patients (62 % vs 77 %, p = 0.0002), while LC and DFS did not differ. Patients undergoing postoperative radiation attained a higher OS compared to the definitively irradiated subgroup with 74 vs. 60 % at 3 years (p = 0.01); however, DFS rates were similar for both groups (68 vs. 61 %, p = 0.15). Corresponding rates for >1400 HNT patients <80 years treated during the same time interval were 81/80 %, 69/67 %, and 77/72 %, respectively. Conclusions Treatment tolerance in our patients aged 80+ was high. These results suggest that elderly HNT patients should not be denied potentially curative treatment strategies.
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Affiliation(s)
- Michelle L Brown
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Christoph Glanzmann
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Gerhard Huber
- Department of Otorhinolaryngology, Head Neck Cancer Center, Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marius Bredell
- Department of Craniomaxillofacial and Oral Surgery, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Tamara Rordorf
- Department of Medical Oncology, Head Neck Cancer Center, University Hospital Zurich, Zurich, Switzerland
| | - Gabriela Studer
- Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
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Concurrent chemoradiotherapy in older adults with squamous cell head & neck cancer: Evidence and management. J Geriatr Oncol 2016; 7:145-53. [PMID: 26924572 DOI: 10.1016/j.jgo.2016.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/06/2015] [Accepted: 01/29/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Treatment for head and neck cancers incurs substantial associated morbidities, which can be of potentially greater significance in older patients. Though the geriatric population forms a substantial portion of patients with head and neck cancers, this group remains underrepresented in large clinical trials. Hence, management for this unique subpopulation remains empiric and mostly based on data from younger patients. MATERIALS AND METHODS Review of key publications on geriatric patients treated for head and neck cancers. CONCLUSIONS We discuss data regarding chemoradiation for head and neck cancers, as well as management of associated side effects in this population. We encourage oncologists to treat older patients not as a homogeneous subpopulation, but rather assess several factors associated with potential tolerance to chemoradiotherapy. Aggressive supportive treatments for chemoradiotherapy toxicities are highly encouraged in this population, and with new technical/technological developments, there is potential to continually reduce toxicity in this cohort in the future.
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Rogers S, Audisio R, Lowe D. Do the elderly raise different issues when using the Patient Concerns Inventory in routine head and neck cancer follow-up clinics? Eur J Cancer Care (Engl) 2015; 24:189-97. [DOI: 10.1111/ecc.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S.N. Rogers
- Evidence-Based Practice Research Centre (EPRC); Faculty of Health and Social Care; Edge Hill University; Ormskirk UK
- Regional Maxillofacial Unit; University Hospital Aintree; Liverpool UK
| | - R.A. Audisio
- St Helens Teaching Hospital; University of Liverpool; St Helens UK
| | - D. Lowe
- Evidence-Based Practice Research Centre (EPRC); Faculty of Health and Social Care; Edge Hill University; Ormskirk UK
- Regional Maxillofacial Unit; University Hospital Aintree; Liverpool UK
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28
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Wu H, Huang S, Zhang D. Autophagic responses to hypoxia and anticancer therapy in head and neck cancer. Pathol Res Pract 2015; 211:101-8. [DOI: 10.1016/j.prp.2014.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/21/2014] [Accepted: 11/11/2014] [Indexed: 02/07/2023]
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[Clinical aspects of transoral laser surgery and neck dissection for oro- and hypopharyngeal cancer in elderly patients]. HNO 2015; 62:342-9. [PMID: 24633392 DOI: 10.1007/s00106-014-2852-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The number of elderly patients with head and neck cancer is increasing. However, there are few valid data on postoperative course after head and neck cancer surgery in elderly patients. The aim of this study was to evaluate the oncological outcome of elderly patients after surgical treatment for oro- and hypopharyngeal cancer. MATERIAL AND METHODS The clinical data of 81 patients, separated into two age groups (62 < 65 years vs. 19 ≥ 65 years), were retrospectively analysed. The cohort comprised T1 and T2 oro- and hypopharyngeal cancer patients, who had undergone primary treatment with transoral laser surgery and neck dissection. Overall and disease-free survival times of the patients were analysed. Additionally, comorbidities and perioperative complications were compared between the two age groups. Median follow-up time was 5.9 years. RESULTS Comparison of different clinical and histopathological data revealed no significant differences between the age groups. The Kaplan-Meier method revealed no significant difference in disease-free survival between the age groups (p = 0.52). Age had no effect on disease-free survival in uni- or multivariate analysis (p = 0.53 vs. 0.94). Surgery-related complications were observed in 13 patients (16 %), 11 cases of which concerned the younger group of patients. CONCLUSION Transoral laser surgery and neck dissection can lead to satisfactory oncological and surgical outcomes in elderly patients with oro- and hypopharyngeal cancer.
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Guntinas-Lichius O, Wendt TG, Kornetzky N, Buentzel J, Esser D, Böger D, Müller A, Schultze-Mosgau S, Schlattmann P, Schmalenberg H. Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry. Oral Oncol 2014; 50:1157-64. [DOI: 10.1016/j.oraloncology.2014.09.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/18/2014] [Accepted: 09/28/2014] [Indexed: 12/24/2022]
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Vargo JA, Ferris RL, Clump DA, Heron DE. Stereotactic body radiotherapy as primary treatment for elderly patients with medically inoperable head and neck cancer. Front Oncol 2014; 4:214. [PMID: 25157336 PMCID: PMC4128217 DOI: 10.3389/fonc.2014.00214] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 07/25/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE With a growing elderly population, elderly patients with head and neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated co-morbidities, and conventional local therapies, such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients' quality of life (QoL). Stereotactic body radiotherapy (SBRT) is a well-established curative strategy for medical-inoperable early-stage lung cancers even in elderly populations; however, there is limited data examining SBRT as primary therapy in head and neck cancer. MATERIAL/METHODS Twelve patients with medically inoperable head and neck cancer treated with SBRT ± cetuximab from 2002 to 2013 were retrospectively reviewed. SBRT consisted of primarily 44 Gy in five fractions delivered on alternating days over 1-2 weeks. Concurrent cetuximab was administered at a dose of 400 mg/m(2) on day -7 followed by 250 mg/m(2) on day 0 and +7 in n = 3 (25%). Patient-reported quality of life (PRQoL) was prospectively recorded using the previously validated University of Washington quality of life revised (UW-QoL-R). RESULTS Median clinical follow-up was 6 months (range: 0.5-29 months). The 1-year actuarial local progression-free survival, distant progression-free survival, progression-free survival, and overall survival for definitively treated patients were 69, 100, 69, and 64%, respectively. One patient (8%) experienced acute grade 3 dysphagia and one patient (8%) experienced late grade 3 mucositis; there were no grade 4-5 toxicities. Prospective collection of PRQoL as assessed by UW-QoL-R was preserved across domains. CONCLUSION Stereotactic body radiotherapy shows encouraging survival and relatively low toxicity in elderly patients with unresectable head and neck cancer, which may provide an aggressive potentially curative local therapy while maintaining QoL.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Robert L Ferris
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology, Division of Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA ; Department of Otolaryngology, Division of Head and Neck Surgery, University of Pittsburgh Cancer Institute , Pittsburgh, PA , USA
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Addeo R, Napolitano A, Montella L, Ricciardiello F. Squamous cell carcinoma of the tongue in a female with advanced breast cancer: A case report of an elderly patient presenting with two types of cancer. Oncol Lett 2014; 8:235-237. [PMID: 24959252 PMCID: PMC4063625 DOI: 10.3892/ol.2014.2097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 04/04/2014] [Indexed: 11/05/2022] Open
Abstract
Elderly patients with cancer are frequently undertreated as they are considered to be unfit for treatment due to inaccurate estimations of the operative risk. In the current study, the case of an 81-year-old female smoker with advanced breast cancer is presented. The patient had received numerous cycles of chemo- and hormonal therapy and the cancer only progressed locally. After six years, the patient developed a second type of cancer; a moderately differentiated squamous cell carcinoma of the tongue. The patient refused any local treatment and she received supportive care only. There is currently a lack of data regarding the molecular mechanisms of second primary cancers as well as other delayed outcomes following cancer treatment. Therefore, it is proposed that chemotherapy may promote the presentation of the second cancer as a result of immunosuppression.
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Affiliation(s)
- Raffaele Addeo
- Medical Oncology Unit, The San Giovanni di Dio Hospital, Frattamaggiore, Naples 80027, Italy
| | | | - Liliana Montella
- Medical Oncology Unit, The San Giovanni di Dio Hospital, Frattamaggiore, Naples 80027, Italy
| | - Filippo Ricciardiello
- Department of Clinical Otology, ENT Clinic, 'Federico II' University, Naples 80131, Italy
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Head and Neck Cancer in the Older Adult: Approaches in Evaluation and Management. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0089-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lee JC, Chang SH, Yang CC, Hsieh CH, Chen YJ. Elderly Patients with Laryngeal and Hypopharyngeal Cancer Undergoing Total Pharyngolaryngectomy with a Radial Forearm, Free Flap-reconstructed Phonation Tube. INT J GERONTOL 2014. [DOI: 10.1016/j.ijge.2013.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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VanderWalde NA, Meyer AM, Deal AM, Layton JB, Liu H, Carpenter WR, Weissler MC, Hayes DN, Fleming ME, Chera BS. Effectiveness of Chemoradiation for Head and Neck Cancer in an Older Patient Population. Int J Radiat Oncol Biol Phys 2014; 89:30-7. [DOI: 10.1016/j.ijrobp.2014.01.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/08/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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36
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VanderWalde NA, Meyer AM, Liu H, Tyree SD, Zullig LL, Carpenter WR, Shores CD, Weissler MC, Hayes DN, Fleming M, Chera BS. Patterns of care in older patients with squamous cell carcinoma of the head and neck: a surveillance, epidemiology, and end results-medicare analysis. J Geriatr Oncol 2013; 4:262-70. [PMID: 24058388 PMCID: PMC3775263 DOI: 10.1016/j.jgo.2013.03.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is growing evidence in the literature that older patients may not benefit from more intensive therapy for head and neck squamous cell carcinoma (HNSCC). A growing number of patients with HNSCC are age 65 years or older; however, much of the evidence base informing treatment decisions is based on substantially younger and healthier clinical trial populations. The purpose of this study was to assess the patterns of care of older HNSCC patients to better understand how age is associated with treatment decisions. METHODS Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (1992–2007), we identified patients with non-metastatic HNSCC (n = 10,867) and categorized them by treatment: surgery vs. non-surgery and chemoradiotherapy (CRT) vs. radiotherapy (RT). Multivariate logistic regression models were used to identify variables associated with the receipt of surgery and CRT. RESULTS Increasing age was associated with decreased odds of receiving CRT (OR = 0.94; 95% CI 0.93–0.94) but not surgery (OR 1.00; 95% CI 0.99–1.00). Co-morbidity and race were not associated with receipt of either surgery or CRT. Utilization of CRT increased while surgery decreased between 1992 and 2007. CONCLUSION Age may influence the receipt of CRT for older HNSCC patients. There has been an increasing trend in the receipt of CRT and a decrease in primary surgery.
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Affiliation(s)
- Noam A. VanderWalde
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, CB 7600, Chapel Hill, NC 27514
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Anne-Marie Meyer
- Department of Health Policy and Management, Gillings School of Public Health, 135 Dauer Dr., Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Huan Liu
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Seth D. Tyree
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Leah L. Zullig
- Department of Health Policy and Management, Gillings School of Public Health, 135 Dauer Dr., Chapel Hill, NC 27599
| | - William R. Carpenter
- Department of Health Policy and Management, Gillings School of Public Health, 135 Dauer Dr., Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Carol D. Shores
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, 170 Manning Drive, CB 7070, Physician’s Office Bldg, Room G-190, Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Mark C. Weissler
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina, 170 Manning Drive, CB 7070, Physician’s Office Bldg, Room G-190, Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - David N. Hayes
- Department of Medicine, Division of Hematology and Oncology, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC 27599
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Mary Fleming
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, CB 7600, Chapel Hill, NC 27514
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
| | - Bhishamjit S. Chera
- Department of Radiation Oncology, University of North Carolina, 101 Manning Drive, CB 7600, Chapel Hill, NC 27514
- Lineberger Comprehensive Cancer Center, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514
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