Adjuvant chemoradiation after surgical resection in elderly patients with high-risk squamous cell carcinoma of the head and neck: a National Cancer Data Base (NCDB) analysis

Publication date: Available online 18 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Neil M. Woody, Matthew C. Ward, Shlomo A. Koyfman, Chandana A. Reddy, Jessica Geiger, Nikhil Joshi, Brian Burkey, Joseph Scharpf, Eric Lamarre, Brandon Prendes, David J. Adelstein
Purpose/Objective: To determine the patterns of adjuvant chemoradiotherapy use in elderly patients treated with definitive surgical resection for squamous cell carcinoma (SCC) of the head and neck with extracapsular extension or positive margins and determine if an association with overall survival exists with adjuvant concurrent chemoradiotherapy (CRT).Materials/MethodsThe National Cancer Data Base (NCDB) was queried to identify patients with SCC of the oral cavity, oropharynx, larynx and hypopharynx who were treated with primary definitive surgery and adjuvant radiotherapy between 2004 and 2012. For elderly patients (age >70 years) with pathology revealing extracapsular extension (ECE) or positive margin, the benefit of concurrent chemotherapy was explored using multivariable Cox proportional hazards modeling.Results7,349 patients were identified meeting study criteria of whom 1,187 were elderly (age > 70) with a median follow up of 30.6 months. 445 of these elderly patients had ECE or positive margin and represent the study population of whom 187 (42%) received CRT. Delivery of CRT in this cohort increased over the study period and IMRT was associated with increased use of CRT (OR = 2.07; p=0.004). Increasing age was associated with reduced use of CRT (OR 0.88; p<0.001). CRT was associated with a significant improvement in OS on multivariable model (HR 0.74; p=0.04) and a trend towards significance on inverse propensity score analysis (HR 0.78; p=0.051). Three year OS was 53.8% in the CRT group compared to 44.6% in the adjuvant RT alone patients.ConclusionsThe use of adjuvant CRT is increasing among elderly patients with resected squamous cell carcinoma of the head and neck exhibiting ECE or positive margins. CRT was associated with an improvement in overall survival on multivariable analysis but not propensity weighted analysis. Among fit elderly patients with ECE or positive margins after definitive surgical resection, concurrent chemotherapy can be carefully considered.



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