Feasibility of Adjuvant Radiotherapy or Chemoradiation for Elderly Patients with Squamous Cell Carcinoma of the Head and Neck, and Its Correlation with Different Comorbidity Scores: A Retrospective Cohort Study

TL;DR

This study shows that elderly patients with head and neck cancer can safely receive radiation therapy or combined radiation and chemotherapy, with outcomes influenced more by health than age.

Contribution

The study demonstrates that age alone should not disqualify elderly patients from standard cancer treatments like radiotherapy or chemoradiation.

Findings

Elderly patients over 70 can complete adjuvant radiotherapy or chemoradiation with high success rates.

Health and frailty scores, not age, better predict treatment tolerance in elderly cancer patients.

Local tumor control rates were high, with 99% at 12 months and 76% at 5 years.

Abstract

This study examined how well elderly patients with head and neck cancer tolerated radiation therapy or combined radiation and chemotherapy after surgery. We found that treatment outcomes were affected more by patients’ overall health and level of frailty than by age alone, while health scoring systems helped to predict tolerability. These findings suggest that older patients should not be denied standard cancer treatment just because of their age.

Background: With aging populations, the incidence of squamous cell carcinoma of the head and neck (SCCHN) among elderly patients is increasing. Although adjuvant radiotherapy or chemoradiation is a well-established component of multimodal treatment, elderly patients remain underrepresented in clinical trials. This study evaluates the feasibility of adjuvant radiotherapy and chemoradiation in patients over 70 years with SCCHN and explores the correlation between treatment feasibility and various comorbidity scores. Methods: We retrospectively analyzed patients over 70 years of age who received adjuvant radiotherapy or chemoradiation at the University Hospital Regensburg between 2004 and 2018. A total of 71 patients, with a median age of 75 years, were included. The majority were classified as UICC stage IVa. Median follow-up was 27 months. Results: Sixty-two patients completed treatment without interruption, and sixty-five received at least 95% of the prescribed radiation dose. The median total dose was 64 Gy. Acute toxicity of grade III or IV (CTC) occurred in 37 patients. Local tumor control rates were 99% at 12 months, 88% at 24 months, and 76% at 5 years. Overall survival rates were 87% at 12 months, 67% at 24 months, and 41% at 60 months, with a median overall survival of 51 months. The Elixhauser Comorbidity Score showed significant predictive value for treatment feasibility (p = 0.006). Conclusions: Adjuvant radiotherapy and chemoradiation are feasible and effective treatment options for elderly patients with SCCHN. The favorable local and locoregional control rates reported here suggest, in line with other recent reports in the literature, that age alone should not be a justification for treatment de-intensification.

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