Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer

Megan E Daly, Derick H Lau, D Gregory Farwell, Quang Luu, Paul J. Donald, Allen M. Chen

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objectives: Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer. Design: Retrospective review. Setting: Tertiary care center. Participants: Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to > 95% of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months). Main outcomes measures: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0. Results Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55%. Conclusion: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.

Original languageEnglish (US)
Pages (from-to)631-635
Number of pages5
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Volume34
Issue number6
DOIs
StatePublished - Nov 2013

Fingerprint

Head and Neck Neoplasms
Radiation
Patient Selection
Hospitalization
Therapeutics
Osteoradionecrosis
Skin
Gastrostomy
Kaplan-Meier Estimate
Paclitaxel
Platinum
Tumor Burden
Tertiary Care Centers
Outcome Assessment (Health Care)
Drug Therapy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

@article{f32816166d9f419983d5eb47be6a3dc5,
title = "Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer",
abstract = "Objectives: Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer. Design: Retrospective review. Setting: Tertiary care center. Participants: Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to > 95{\%} of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months). Main outcomes measures: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0. Results Eight patients (20{\%}) required a radiation treatment break of ≥ 3 days. Thirteen (33{\%}) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55{\%}. Conclusion: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.",
author = "Daly, {Megan E} and Lau, {Derick H} and Farwell, {D Gregory} and Quang Luu and Donald, {Paul J.} and Chen, {Allen M.}",
year = "2013",
month = "11",
doi = "10.1016/j.amjoto.2013.07.010",
language = "English (US)",
volume = "34",
pages = "631--635",
journal = "American Journal of Otolaryngology - Head and Neck Medicine and Surgery",
issn = "0196-0709",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer

AU - Daly, Megan E

AU - Lau, Derick H

AU - Farwell, D Gregory

AU - Luu, Quang

AU - Donald, Paul J.

AU - Chen, Allen M.

PY - 2013/11

Y1 - 2013/11

N2 - Objectives: Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer. Design: Retrospective review. Setting: Tertiary care center. Participants: Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to > 95% of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months). Main outcomes measures: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0. Results Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55%. Conclusion: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.

AB - Objectives: Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer. Design: Retrospective review. Setting: Tertiary care center. Participants: Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to > 95% of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months). Main outcomes measures: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0. Results Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55%. Conclusion: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.

UR - http://www.scopus.com/inward/record.url?scp=84887093593&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887093593&partnerID=8YFLogxK

U2 - 10.1016/j.amjoto.2013.07.010

DO - 10.1016/j.amjoto.2013.07.010

M3 - Article

C2 - 23954137

AN - SCOPUS:84887093593

VL - 34

SP - 631

EP - 635

JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery

JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery

SN - 0196-0709

IS - 6

ER -