Medical Oncology

, 36:42 | Cite as

Individualized treatment of head neck squamous cell carcinoma patients aged 70 or older with radiotherapy alone or associated to cisplatin or cetuximab: impact of weekly radiation dose on loco-regional control

  • Liliana BelgioiaEmail author
  • Almalina Bacigalupo
  • Francesco Missale
  • Stefania Vecchio
  • Ilaria Chiola
  • Serena Callegari
  • Elisa Verzanini
  • Giorgio Peretti
  • Renzo Corvò
Original Paper


The purpose of this study is to evaluate if, in elderly HNC patients, loco-regional control (LRC) is influenced by average weekly radiation dose (AWD). From 2009 to 2017, 150 consecutive HNC elderly patients were analyzed. AWD was calculated by dividing total dose in Gray by overall treatment time in weeks. Patients were divided in 2 groups: Group 1 (70–75 years) and Group 2 (> 75 years). Primary endpoint was LRC; secondary endpoints were overall survival (OS) and compliance to treatment. The median age was 76 years (range 70–92), the distribution of patients by age was 72 and 78 patients in Group 1 and in Group 2, respectively; overall median follow-up was 23 months. Optimal cut-off of AWD for LRC was 9.236 (p = 0.018). Median OS was 73 months. In univariate survival analysis low PS (p = 0.005), T3–T4 (p = 0.021), Stage III–IV (p = 0.046) and AWDLow (< 9.236) (p = 0.018) were significantly associated with lower LRC; low PS (p < 0.001) and Group 2 (p = 0.006) were also associated with lower OS. Considering patients treated with radiotherapy alone AWDLow was significantly associated with lower LRC (p = 0.04) whereas among patient treated with chemoradiotherapy AWD did not affected LRC (p = 0.18). The multivariate analysis confirmed the significant value of PS for the prediction of LRC and OS (p = 0.035 and p < 0.001, respectively). In elderly patients an AWD of > 9.236 Gy was found to be beneficial for RT alone regimen. When radiotherapy alone is indicated in elderly patients an effort should be made to maintain an increased AWD in order to improve LRC.


Head neck cancer Elderly Average weekly dose Loco-regional control Chemoradiotherapy Radical radiotherapy 


Author contributions

LB, AB, FM, RC contributed to study concepts and design; IC, SC, EV data collection; LB, FM data analysis and interpretation; FM statistical analysis; LB manuscript preparation and editing; AB, RC, GP, SV manuscript review.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health Sciences (DISSAL)University of GenoaGenoaItaly
  2. 2.Radiation Oncology DepartmentIRCCS Ospedale Policlinico San MartinoGenoaItaly
  3. 3.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of GenoaGenoaItaly
  4. 4.IRCCS Ospedale Policlinico San MartinoGenoaItaly
  5. 5.Medical Oncology DepartmentIRCCS Ospedale Policlinico San MartinoGenoaItaly

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