Different definitive radiotherapy approaches in indian elderly head and neck cancer patients: Experience from an Indian Center

• Main Authors: Kazi Sazzad Manir, Swapnendu Basu, Sourav Guha, Manish Goswami, Jyotirup Goswami, Suman Mallik
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Journal of Head & Neck Physicians and Surgeons
• Subjects: Elderly; head and neck cancer; radical radiotherapy
• Online Access: http://www.jhnps.org/article.asp?issn=2347-8128;year=2019;volume=7;issue=1;spage=16;epage=19;aulast=Manir

Introduction: Treatment of Squamous Cell Carcinoma of Head and Neck (SCCHN) in elderly age group is challenging. Role of either curative concurrent chemoradiation (ChTRT) or Accelerated Fractionation Radiotherapy(ACRT) in this subgroup is not clearly defined. Materials and Methods: Between July 2015 and December 2017, we treated 61 elderly (>70 years) SCCHN patients (excluding T1/T2N0M0 Ca Glottis). 18 patients had been excluded from analysis for <6-month follow-up. 3 patients were excluded as they did not complete Radiotherapy (RT). We retrospectively analyzed 40 patients who were treated with definitive RT (ChTRT [18]/ACRT [10]/RT only [12]). Clinical outcomes and acute toxicities (≥ Grade 2 in Common Terminology Criteria for Adverse Events v5.0 scale) were compared between different treatment groups. Results: Our study population had a median follow-up of 8 months (6–32 months), median age of 73 years (70–93 years) with 52.5% patients of Stage IVA, and 40% oropharyngeal malignancies. 66.7% patients were able to take all intended ChT cycles. 22% patients in ChTRT, 10% patients in ACRT, and 16% patients in RT only arm has acute (≥ Grade 2) skin reaction. For mucositis, the incidences were 38.9%, 30%, and 8.3%, respectively. For dysphagia, the incidences were 44.4%, 40%, and 50%, respectively. For pain, the incidences were 50%, 40%, and 50%, respectively. One patient (7.5%, in ChTRT arm) died due to severe dysphagia after completion of RT. 7.5% patient had significant treatment delay (>7 days). Complete response rate was better in ChTRT arm than others (94.4%, 80%, and 75%, respectively) Median progression-free survival (PFS) was better in ChTRT arm (5 months with a range of 3.4–6.6 months) than ACRT and RT only arm (both arms had median PFS of 3 months). Conclusion: All radical RT approaches are feasible and effective in Indian elderly SCCHN patients. Definitive ChTRT is better in terms of CR rate and PFS but with more acute toxicities. Radical treatment strategy of elderly should be guided by clinical judgments not by chronological age.