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A Reappraisal of Definitive Chemoradiotherapy for Older Adults With Advanced Head and Neck Cancer.
Smile, Timothy D; Reddy, Chandana A; Matia, Brian; Fleming, Christopher W; Domb, Chaim; Geiger, Jessica L; Joshi, Nikhil P; Woody, Neil M; Chute, Deborah J; Griffith, Christopher C; Adelstein, David J; Koyfman, Shlomo A.
Afiliación
  • Smile TD; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.; smilet@ccf.org.
  • Reddy CA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Matia B; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Fleming CW; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Domb C; Case Western Reserve University College of Medicine, Cleveland, OH, U.S.A.
  • Geiger JL; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Joshi NP; Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, U.S.A.
  • Woody NM; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Chute DJ; Department of Pathology, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Griffith CC; Department of Pathology, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Adelstein DJ; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
  • Koyfman SA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
Anticancer Res ; 42(8): 3845-3852, 2022 Aug.
Article en En | MEDLINE | ID: mdl-35896238
BACKGROUND/AIM: Definitive treatment for locally advanced head and neck squamous cell carcinoma (LAHNSCC) is often compromised in older adults due to concerns about potential treatment toxicity intolerance. We reviewed our institutional experience with definitive management of older adults with LAHNSCC. PATIENTS AND METHODS: From our Institutional Review Board-approved registry, we identified patients aged >60 years with stage III-IV, M0 LAHNSCC (seventh/earlier editions of the American Joint Committee on Cancer classification) treated with definitive radiotherapy from 1993-2019. Indications for concurrent chemotherapy included T3-4 or N2-3 disease. Multivariable analysis using Fine and Gray regression was performed to identify risk factors associated with recurrence. The cumulative incidence method was used to calculate recurrence rates. RESULTS: Overall, 350 patients were identified: 223 aged 60-69, 82 aged 70-74, and 45 aged ≥75 years. Median follow-up was 36.3 months. Two-year recurrence rates were 13.7%, 20.2% and 34.8%, respectively; human papillomavirus-positive disease was present in 190 (85%), 44 (54%), and 25 (56%), respectively; and systemic therapy was given to 194 (87%), 64 (88%), and 23 (56%) patients, respectively. Factors significantly associated with increased risk of recurrence included age ≥75 years, Karnofsky performance status 70-80, clinical N2c-N3, and Charlson score 2-3. CONCLUSION: Patients aged ≥75 years received less aggressive therapy and experienced increased recurrence compared to younger patients. Outcomes for those aged 70-74 years were similar to younger patients treated with aggressive therapy, despite their inferior performance status/comorbidity, and such patients should not routinely be excluded from standard-of-care therapy. Further study is needed to optimize therapy for a redefined older adult (age ≥75 years) population.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Escamosas / Infecciones por Papillomavirus / Neoplasias de Cabeza y Cuello Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Anticancer Res Año: 2022 Tipo del documento: Article Pais de publicación: Grecia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Carcinoma de Células Escamosas / Infecciones por Papillomavirus / Neoplasias de Cabeza y Cuello Tipo de estudio: Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Anticancer Res Año: 2022 Tipo del documento: Article Pais de publicación: Grecia