Characteristics and treatment patterns in older patients with locally advanced head and neck cancer (KCSG HN13-01)
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Background/Aims: Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. Methods: Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III–IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. Results: Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. Conclusions: Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
Abstract
Background/Aims: Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. Methods: Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III–IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. Results: Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. Conclusions: Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
참고문헌 (28)
- Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016", Cancer Research and Treatment, 51(2), pp.417~430 (2019), 대한암학회
- "Annual report of cancer statistics in Korea in 2018" (2021)[URL]
- Kruse AL, "Head and neck cancer in the elderly : a retrospective study over 10 years(1999-2008)", Head Neck Oncol, 2, pp.25~ (2010)
- Huang SH, "Patterns of care in elderly head-and-neck cancer radiation oncology patients : a single-center cohort study", Int J Radiat Oncol Biol Phys, 79, pp.46~51 (2011)
- Noor A, "Frailty in geriatric head and neck cancer : a contemporary review", Laryngoscope, 128, pp.E416~E424 (2018)
- Paleri V, "Comorbidity in head and neck cancer : a critical appraisal and recommendations for practice", Oral Oncol, 46, pp.712~719 (2010)
- Derks W, "Elderly patients with head and neck cancer : the influence of comorbidity on choice of therapy, complication rate, and survival", Curr Opin Otolaryngol Head Neck Surg, 13, pp.92~96 (2005)
- Pallis AG, "EORTC elderly task force position paper : approach to the older cancer patient", Eur J Cancer, 46, pp.1502~1513 (2010)
- Balducci L, "Geriatric oncology : challenges for the new century", Eur J Cancer, 36, pp.1741~1754 (2000)
- Italiano A, "Head and neck squamous cell carcinoma in patients aged > or = 80 years : patterns of care and survival", Cancer, 113, pp.3160~3168 (2008)
- Barros-Silva PG, "Clinical-pathological and sociodemographic factors associated with the distant metastasis and overall survival of oral cavity and oropharynx squamous cell carcinoma", Med Oral Patol Oral Cir Bucal, 25, pp.e375~e382 (2020)
- Wagner S, "Human papillomavirus-related head and neck cancer", Oncol Res Treat, 40, pp.334~340 (2017)
- Rettig EM, "Epidemiology of head and neck cancer", Surg Oncol Clin N Am, 24, pp.379~396 (2015)
- Chaturvedi AK, "Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers", J Clin Oncol, 31, pp.4550~4559 (2013)
- Bhattacharyya N, "A matched survival analysis for squamous cell carcinoma of the head and neck in the elderly", Laryngoscope, 113, pp.368~372 (2003)
- Argiris A, "Outcome of elderly patients with recurrent or metastatic head and neck cancer treated with cisplatin-based chemotherapy", J Clin Oncol, 22, pp.262~268 (2004)
- Lusinchi A, "Radiation therapy for head and neck cancers in the elderly", Int J Radiat Oncol Biol Phys, 18, pp.819~823 (1990)
- Moye VA, "Elderly patients with squamous cell carcinoma of the head and neck and the benefit of multimodality therapy", Oncologist, 20, pp.159~165 (2015)
- Juarez JE, "Patterns of care for elderly patients with locally advanced head and neck cancer", Int J Radiat Oncol Biol Phys, 98, pp.767~774 (2017)
- Vermorken JB, "Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer", N Engl J Med, 357, pp.1695~1704 (2007)
- Lorch JH, "Induction chemotherapy with cisplatin and fluorouracil alone or in combination with docetaxel in locally advanced squamous-cell cancer of the head and neck : long-term results of the TAX 324 randomised phase 3 trial", Lancet Oncol, 12, pp.153~159 (2011)
- Posner MR, "Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer", N Engl J Med, 357, pp.1705~1715 (2007)
- Blanchard P, "Taxane-cisplatin-fluorouracil as induction chemotherapy in locally advanced head and neck cancers : an individual patient data meta-analysis of the meta-analysis of chemotherapy in head and neck cancer group", J Clin Oncol, 31, pp.2854~2860 (2013)
- Driessen CM, "Induction chemotherapy with docetaxel", cisplatin, Eur J Cancer, pp.2016, 52[DOI]
- Hitt R, "A randomized phase III trial comparing induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as treatment of unresectable head and neck cancer", Ann Oncol, 25, pp.216~225 (2014)
- Lee SY, "Comparison of standard-dose 3-weekly cisplatin and low-dose weekly cisplatin for concurrent chemoradiation of patients with locally advanced head and neck squamous cell cancer: a multicenter retrospective analysis", Medicine(Baltimore), 97, pp.e10778~ (2018)
- Szturz P, "Weekly low-dose versus three-weekly high-dose cisplatin for concurrent chemoradiation in locoregionally advanced non-nasopharyngeal head and neck cancer : a systematic review and meta-analysis of aggregate data", Oncologist, 22, pp.1056~1066 (2017)