In the Journals

Older patients with HNSCC face higher toxicity risk from chemotherapy, radiation

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March 18, 2015

The potential benefit of adding chemotherapy to radiation does not appear to outweigh the  risks for toxicity among older patients with locally or regionally advanced head and neck squamous cell carcinoma, according to results of a SEER analysis.

“Over the past 2 decades, combined-modality treatment with chemotherapy and radiation therapy has gained widespread acceptance, as numerous studies have demonstrated improved locoregional control and survival in comparison with radiation therapy alone,” Caitriona B. O’Neill, PhD, of the School of Pharmacy and Pharmaceutical Sciences at the Panoz Institute of Trinity College in Dublin, Ireland, and colleagues wrote. “Despite these advantages, the benefit of chemotherapy and radiation therapy may be offset by acute and often severe treatment-related toxicities, particularly among older patients and those with comorbid medical conditions or a poor performance status.”

O’Neill and colleagues used the SEER–Medicare database to identify 2,277 patients (75% male) aged 66 years or older who were diagnosed with head and neck squamous cell carcinoma (HNSCC) between 2001 and 2009.

Two-thirds of the patients (66%; n = 1502) received combined-modality treatment with chemotherapy and radiation, and 34% (n = 775) received radiation alone.

Hospitalization and ER visits for an acute toxicity occurred in a significantly greater proportion of patients who received combined-modality treatment (62% vs. 46%; P ˂ .0001). A significantly greater proportion of patients who underwent combined-modality treatment were hospitalized for gastrointestinal (10% vs. 3%; P < .0001), hematological (31% vs. 14%; P < .0001) and oral (30% vs. 18%; P ˂ .0001) toxicities.

Overall, patients who received combined-modality treatment were twice as likely as those who received radiation alone to experience any acute toxicity (OR = 2.1; 95% CI, 1.72-2.56).

Further, 54% of patients in the combined-modality cohort were placed on a feeding tube after treatment compared with 32% of radiation patients (P < .0001).

These findings may enable doctors to utilize combined-modality treatment among populations that would derive greater benefit from it, the researchers wrote.

“Although the survival benefit associated with chemotherapy and radiation therapy is well established in younger patients, it is not clear whether the benefit of adding chemotherapy to radiation therapy exceeds the risk of toxicity associated with this therapy in older patients,” O’Neill and colleagues wrote. “Risk-stratified approaches may improve overall outcomes in HNSCC by directing more aggressive treatment modalities to patients with a greater likelihood of benefit and a greater ability to tolerate side effects. Such strategies would reduce the use of combined-modality therapy in those who are least likely to benefit from it and least able to tolerate it, spare them unnecessary toxicity, and reduce costs to the patient, the payer and the society at large.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.