The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era.

Abstract

BACKGROUND:

Despite controversy surrounding its benefit, the use of concomitant chemoradiotherapy (CCRT) in patients with oropharyngeal squamous cell carcinoma (OPSCC) who are aged > 70 years is increasing. However, to the authors' knowledge, few studies to date have compared the outcomes of different systemic treatments in this population.

METHODS:

Records from 74 patients aged ≥ 70 years with stage III to stage IVB OPSCC who were undergoing CCRT from 2002 to 2013 at a single institution were reviewed. Patients were stratified according to the systemic therapy received, including cisplatin, carboplatin with either 5-fluorouracil or paclitaxel (CARB), or cetuximab to compare oncologic outcome and toxicity.

RESULTS:

The median follow-up was 36 months. The median age of the patients was 75.3 years (range, 70-91 years), with significantly older patients receiving cetuximab (P = .03). A total of 28, 20, and 26 patients, respectively, received CCRT with cisplatin, CARB, and cetuximab. RT interruptions of > 1 day were needed in 4% of patients receiving cisplatin, 20% of patients receiving CARB, and 15% of patients receiving cetuximab (P = .19). Unplanned hospitalizations during CCRT occurred in 25%, 55%, and 58%, respectively, of patients receiving cisplatin, CARB, and cetuximab (P = .03). There were 2 treatment-related deaths, both of which occurred among the patients who were treated with cetuximab. At 5 years, locoregional control was achieved in 100%, 88%, and 60% (P<.001), respectively, and the overall survival rate was 87%, 61%, and 47% (P = .03), respectively, among patients treated with cisplatin, CARB, and cetuximab.

CONCLUSIONS:

Toxicity from CCRT remains a challenge for older adults with OPSCC. Herein, the authors found no evidence that this toxicity was mitigated by treatment with cetuximab. Nevertheless, a subset of patients aged ≥70 years appear to tolerate cisplatin-based treatment with acceptable toxicity and excellent outcomes. Further identification of this patient subgroup is crucial to optimize therapy for older patients with OPSCC. Cancer 2017;123:1345-1353. © 2016 American Cancer Society.

• Authors: Zachary S Zumsteg, Benjamin H Lok, Allen S Ho, Esther Drill, Zhigang Zhang, Nadeem Riaz, Stephen L Shiao, Jennifer Ma, Sean M McBride, C Jillian Tsai, Shrujal S Baxi, Eric J Sherman, Nancy Y Lee
• Journal: Cancer (Cancer) Vol. 123 Issue 8 Pg. 1345-1353 (04 15 2017) ISSN: 1097-0142 [Electronic] United States
• PMID: 27984656 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: © 2016 American Cancer Society.

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Carcinoma, Squamous Cell (diagnosis, mortality, therapy)
• Chemoradiotherapy (adverse effects, methods)
• Female
• Humans
• Male
• Neoplasm Staging
• Odds Ratio
• Oropharyngeal Neoplasms (diagnosis, mortality, therapy)
• Radiotherapy, Intensity-Modulated (adverse effects, methods)
• Retreatment
• Retrospective Studies
• Risk Factors
• Treatment Outcome