Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy

Ronald Maggiore, Emily K. Curran, Mary Ellyn Witt, Daniel J. Haraf, Everett E. Vokes, Ezra E W Cohen

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objectives: Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population. Materials and Methods: Retrospective study of LA-HNC patients ≥. 70. years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3. years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured. Results: Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76. years; range, 70-94; male, 61%; ECOG PS, 0-1 43%; stage IVA/B, 71%). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32% with a median follow-up time of 39.2. months. The majority (86.5%) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62%) and developed aspiration during swallowing evaluation post-treatment (44%). Several patients required hospice (9%) or skilled nursing facility (13%) referrals during treatment. Conclusion: Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.

Original languageEnglish (US)
Pages (from-to)327-333
Number of pages7
JournalJournal of Geriatric Oncology
Volume4
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

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Head and Neck Neoplasms
Survival
Gastrostomy
Therapeutics
Deglutition
Skilled Nursing Facilities
Hospices
Second Primary Neoplasms
Chemoradiotherapy
Survival Analysis
Fluorouracil
Disease-Free Survival
Referral and Consultation
Survival Rate
Retrospective Studies
Prospective Studies

Keywords

  • Aspiration
  • Chemoradiation
  • Combined modality
  • Elderly
  • Gastrostomy tube
  • Geriatric
  • Head/neck cancer
  • Outcomes
  • Survival

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Oncology

Cite this

Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy. / Maggiore, Ronald; Curran, Emily K.; Witt, Mary Ellyn; Haraf, Daniel J.; Vokes, Everett E.; Cohen, Ezra E W.

In: Journal of Geriatric Oncology, Vol. 4, No. 4, 10.2013, p. 327-333.

Research output: Contribution to journalArticle

Maggiore, Ronald ; Curran, Emily K. ; Witt, Mary Ellyn ; Haraf, Daniel J. ; Vokes, Everett E. ; Cohen, Ezra E W. / Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy. In: Journal of Geriatric Oncology. 2013 ; Vol. 4, No. 4. pp. 327-333.
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abstract = "Objectives: Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population. Materials and Methods: Retrospective study of LA-HNC patients ≥. 70. years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3. years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured. Results: Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76. years; range, 70-94; male, 61{\%}; ECOG PS, 0-1 43{\%}; stage IVA/B, 71{\%}). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32{\%} with a median follow-up time of 39.2. months. The majority (86.5{\%}) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62{\%}) and developed aspiration during swallowing evaluation post-treatment (44{\%}). Several patients required hospice (9{\%}) or skilled nursing facility (13{\%}) referrals during treatment. Conclusion: Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.",
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T1 - Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy

AU - Maggiore, Ronald

AU - Curran, Emily K.

AU - Witt, Mary Ellyn

AU - Haraf, Daniel J.

AU - Vokes, Everett E.

AU - Cohen, Ezra E W

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AB - Objectives: Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population. Materials and Methods: Retrospective study of LA-HNC patients ≥. 70. years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3. years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured. Results: Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76. years; range, 70-94; male, 61%; ECOG PS, 0-1 43%; stage IVA/B, 71%). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32% with a median follow-up time of 39.2. months. The majority (86.5%) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62%) and developed aspiration during swallowing evaluation post-treatment (44%). Several patients required hospice (9%) or skilled nursing facility (13%) referrals during treatment. Conclusion: Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.

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