Korean J Intern Med.  2022 Jan;37(1):190-200. 10.3904/kjim.2020.636.

Characteristics and treatment patterns in older patients with locally advanced head and neck cancer (KCSG HN13-01)

• Kang EJ
• Lee YG
• Keam B
• Choi JH
• Kim JS
• Park KU
• Lee KE
• Kim HJ
• Lee KW
• Kim MK
• Ahn HK
• Shin SH
• Lee JB
• Kwon JH
• Kim HR
• Kim SB
• Yun HJ

• KMID: 2524254
• DOI: http://doi.org/10.3904/kjim.2020.636

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.

Keyword

Aged; Head and neck neoplasms; Therapeutics