Age alone should not be considered the determining factor regarding aggressive treatment with multi-agent concurrent chemoradiotherapy for locally advanced head and neck squamous cell cancer, according to the results of a study presented at the Multidisciplinary Head and Neck Cancer Symposium in Chandler, Arizona, in February 2010.
Multi-agent concurrent chemoradiotherapy (MCCRT) has been shown to improve survival in patients with locally advanced head and neck squamous cell cancer (HNSCC); however there has been some speculation that the treatment strategy may not be appropriate for older patients due to perceived intolerance and reduced benefit.
Researchers conducted a retrospective review of 44 patients aged 70 years or older who were treated with MCCRT between 1989 and 2007 at the Cleveland Clinic. They compared this data to a control group of 137 patients under the age of 70. Treatment included a four-day continuous infusion of fluorouracil and cisplatin during weeks one and four of daily or twice-daily radiation.
Patients in the older group were less likely to receive their second cycle of chemotherapy, with 82% receiving the chemotherapy compared with 96% in the younger group. In addition, the older patients were less likely to undergo radiation twice daily—30% of older patients underwent twice daily radiation compared with 72% of younger patients. Older patients experienced more myelosuppression and required more supportive care; however the outcomes of treatment were similar between the two groups. After a median follow-up of 62 months, the five-year disease-specific survival was 71% for older patients compared with 74% for younger patients. Freedom from recurrence was 69% in the older group and 71% in the younger group.
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The researchers concluded that although the older patients experienced lower blood counts and required more supportive care, their disease-specific survival, recurrence rate, and patterns of failure were similar to younger patients. They suggest that age alone should not be deemed a contraindication to aggressive MCCRT for older patients with HNSCC.
 Michal SA, Adelstein DJ, Rybicki LA, et al. Multi-agent concurrent chemoradiotherapy (MCCRT) for locally advanced head and neck squamous cell cancer (HNSCC) in the elderly. Presented at the Multidisciplinary Head and Neck Cancer Symposium, February 25-27, 2010, Chandler, Arizona. Abstract # 13.