Survival patterns in elderly head and neck squamous cell carcinoma patients treated with definitive radiotherapy

Publication date: Available online 6 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Linda W. Sommers, Roel J.H.M. Steenbakkers, Henk P. Bijl, Johanna G.M. Vemer-van den Hoek, Jan L.N. Roodenburg, Sjoukje F. Oosting, Gyorgy B. Halmos, Sophia E. de Rooij, Johannes A. Langendijk
PurposeTo assess the effect of age on overall survival (OS), cancer-specific survival (CSS) and non-cancer related death (NCRD) of elderly (≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radiotherapy. The results were compared to those of younger patients, and the most important prognostic factors for survival endpoints were determined. Treatments may be better justified based on identification of the main differences in survival between young and elderly patients.Methods and materialsData were analyzed from all consecutive HNSCC patients treated with definitive radiotherapy (66-70 Gy) at our department between April 2007 and December 2014. A total of 674 patients, including 168 elderly patients (24.9%), were included in the study. Multivariable association models were constructed to assess the effect of age on survival endpoints. Multivariate analysis was performed to identify potential prognostic factors for survival in elderly patients.ResultsA total of 674 consecutive patients, including 168 elderly patients were analyzed. Five-year OS and NCRD rates were significantly worse for elderly patients than for the young patients, 45.5% vs. 58.2% (p=0.007) and 39.0% vs. 20.7% (p<0.001) respectively. In the multivariable association analysis on the relationship between age and OS, lymph node involvement and worse WHO performance status were identified as significant confounders. Multivariable association analysis between age and NCRD identified UICC stage as a significant confounder. After correction for confounders, the effect of age on OS and NCRD increased. Worse WHO performance status, lymph node involvement and specific tumor site were independent prognostic factors for OS and CSS in the elderly patient group. Eighty elderly patients (47%) died during follow-up, of which 45% were subscribed to the index tumor. For elderly patients, radiotherapy combined with systemic forms of treatment was significantly associated with adverse NCRD (HR: 8.02; 95%-CI: 2.36 – 27.2; p=0.001) after performing a multivariable association analysis.ConclusionElderly HNSCC patients have worse survival outcomes than younger HNSCC patients. Age is an independent prognostic factor for OS, mainly due to an increase in non-cancer related mortality and comorbid diseases. The differences in CSS between young and elderly patients are negligible.

Teaser

The aim of this study is to investigate overall survival, cancer-specific survival and non-cancer related death in elderly head and neck squamous cell carcinoma patients compared to young patients. We performed a retrospective analysis of prospectively collected data of all consecutive patients treated between April 2007 and December 2014. Age is a prognostic factor for overall survival, mainly due to an increase in non-cancer related mortality rather than to causes related to the index tumor.


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