Anneke Fryen1, Iris Brandes2, Jörn Wichmann3, Hans Christiansen3, Frank Tavassol4, Martin Durisin5, Roland Merten3. 1. Department of Radiation Oncology, Hanover Medical School, Hanover, Germany; anneke.fryen@stud.mh-hannover.de. 2. Department of Epidemiology, Social Medicine and Public Health, Hanover Medical School, Hanover, Germany. 3. Department of Radiation Oncology, Hanover Medical School, Hanover, Germany. 4. Department of Oral and Maxillofacial Surgery, Hanover Medical School, Hanover, Germany. 5. Department of Otolaryngology, Hanover Medical School, Hanover, Germany.
Abstract
BACKGROUND: Comorbidity and frailty are relevant limitations of normofractionated combined radiochemotherapy for squamous cell head and neck cancer (HNSCC), especially in elderly patients. This retrospective study aimed to evaluate the efficacy and toxicity of moderately hypofractionated radiotherapy (HRT) without chemotherapy in patients ineligible for concurrent radiochemotherapy. PATIENTS AND METHODS: Between 2011 and 2018, 51 elderly/frail patients with HNSCC were treated with either definitive (n=23) or adjuvant (n=28) moderate HRT. A dose of 45 Gy was given to the primary tumour region and cervical nodes with a sequential boost up to 50 in the adjuvant and 55 Gy in the definitive cure setting (2.5 Gy/fraction). Patient outcomes of locoregional control, overall survival, and acute and late toxicity were analysed. RESULTS: After a median follow-up of 6 months for the definitive HRT group and 28.5 months for the adjuvant HRT group, we found a median overall survival of 6 vs. 55 months (log-rank test: p<0.001) and a median locoregional control of 9 months vs. not reached (log-rank test: p=0.008), respectively. The 2-year rates of locoregional control were 28.5% for the definitive HRT group vs. 75.2% for the adjuvant HRT group. No acute or late grade 4-5 toxicity occurred; grade 3 toxicity was rarely documented. CONCLUSION: HRT in elderly/frail patients with HNSCC who are unfit for chemotherapy leads to acceptable local control with moderate toxicity in a short overall treatment time. Especially in the postoperative situation, HRT can be considered an appropriate alternative to normofractionated radio(chemo)therapy. Definitive HRT can be a treatment alternative, especially for multimorbid patients.
BACKGROUND: Comorbidity and frailty are relevant limitations of normofractionated combined radiochemotherapy for squamous cell head and neck cancer (HNSCC), especially in elderly patients. This retrospective study aimed to evaluate the efficacy and toxicity of moderately hypofractionated radiotherapy (HRT) without chemotherapy in patients ineligible for concurrent radiochemotherapy. PATIENTS AND METHODS: Between 2011 and 2018, 51 elderly/frail patients with HNSCC were treated with either definitive (n=23) or adjuvant (n=28) moderate HRT. A dose of 45 Gy was given to the primary tumour region and cervical nodes with a sequential boost up to 50 in the adjuvant and 55 Gy in the definitive cure setting (2.5 Gy/fraction). Patient outcomes of locoregional control, overall survival, and acute and late toxicity were analysed. RESULTS: After a median follow-up of 6 months for the definitive HRT group and 28.5 months for the adjuvant HRT group, we found a median overall survival of 6 vs. 55 months (log-rank test: p<0.001) and a median locoregional control of 9 months vs. not reached (log-rank test: p=0.008), respectively. The 2-year rates of locoregional control were 28.5% for the definitive HRT group vs. 75.2% for the adjuvant HRT group. No acute or late grade 4-5 toxicity occurred; grade 3 toxicity was rarely documented. CONCLUSION: HRT in elderly/frail patients with HNSCC who are unfit for chemotherapy leads to acceptable local control with moderate toxicity in a short overall treatment time. Especially in the postoperative situation, HRT can be considered an appropriate alternative to normofractionated radio(chemo)therapy. Definitive HRT can be a treatment alternative, especially for multimorbid patients.
Authors: Jean Bourhis; Jens Overgaard; Hélène Audry; Kian K Ang; Michele Saunders; Jacques Bernier; Jean-Claude Horiot; Aurélie Le Maître; Thomas F Pajak; Michael G Poulsen; Brian O'Sullivan; Werner Dobrowsky; Andrzej Hliniak; Krzysztof Skladowski; John H Hay; Luiz H J Pinto; Carlo Fallai; Karen K Fu; Richard Sylvester; Jean-Pierre Pignon Journal: Lancet Date: 2006-09-02 Impact factor: 79.321
Authors: L J Peters; H Goepfert; K K Ang; R M Byers; M H Maor; O Guillamondegui; W H Morrison; R S Weber; A S Garden; R A Frankenthaler Journal: Int J Radiat Oncol Biol Phys Date: 1993-04-30 Impact factor: 7.038
Authors: P C Levendag; P J Nowak; M J van der Sangen; P P Jansen; W M Eijkenboom; A S Planting; C A Meeuwis; W L van Putten Journal: Am J Clin Oncol Date: 1996-10 Impact factor: 2.339