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
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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.
KeywordsHead neck cancer Elderly Average weekly dose Loco-regional control Chemoradiotherapy Radical radiotherapy
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.
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 was obtained from all individual participants included in the study.
- 8.Bourhis J, Overgaard J, Audry H, et al. Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH) Collaborative Group. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet. 2006;368(9538):843–54. https://doi.org/10.1016/s0140-6736(06)69121-6.CrossRefPubMedGoogle Scholar
- 10.Budczies J, Klauschen F, Sinn BV, Gyorffy B, Schmitt WD, Darb-Esfahani S, Denkert C. Cutoff finder: a comprehensive and straightforward web application enabling rapid biomarker cutoff optimization. PLoS One 2012;7(12):e51862. https://doi.org/10.1371/journal.pone.0051862.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Buglione M, Maddalo M, Corvò R, et al. Subgroup analysis according to human papillomavirus status and tumor site of a randomized phase ii trial comparing cetuximab and cisplatin combined with radiation therapy for locally advanced head and neck cancer. Int J Radiat Oncol Biol Phys. 2017;97(3):462–72. https://doi.org/10.1016/j.ijrobp.2016.10.011.CrossRefPubMedGoogle Scholar
- 20.Russi EG, Moretto F, Rampino M, et al. Acute skin toxicity management in head and neck cancer patients treated with radiotherapy and chemotherapy or EGFR inhibitors: literature review and consensus. Crit Rev Oncol Hematol. 2015;96(1):167–82. https://doi.org/10.1016/j.critrevonc.2015.06.001.CrossRefPubMedGoogle Scholar
- 21.Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced rash and survival. Lancet Oncol. 2010;11(1):21–8. https://doi.org/10.1016/S1470-2045(09)70311-0. (Erratum. In: Lancet Oncol. 2010 Jan; 11(1):14).CrossRefPubMedGoogle Scholar
- 28.Pottel L, Lycke M, Boterberg T, et al. Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life. Eur J Cancer Care (Engl). 2014;23(3):401–12. https://doi.org/10.1111/ecc.12179.CrossRefGoogle Scholar