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Head and Neck Squamous Cell Carcinoma in Patients Aged ‡80 Years Patterns of Care and Survival
Antoine Italiano, MD1 Cecile Ortholan, MD2 Olivier Dassonville, MD3 Gilles Poissonnet, MD3 Juliette Thariat, MD2 Karen Benezery, MD2 Jacques Vallicioni, MD3 Frederic Peyrade, MD1 Pierre-Yves Marcy, MD4 Rene-Jean Bensadoun,
BACKGROUND. Scarce data exist concerning the outcome of very elderly patients with head and neck squamous cell carcinoma (HNSCC).
METHODS. The clinical files of 316 patients aged 80 years with HNSCC who were included in the authors’ hospital database between 1987 and 2006 were reviewed retrospectively.
RESULTS. Approximately 88% of patients received locoregional treatment, 31% of patients underwent surgery, and 57% of patients received definitive radiotherapy. The median disease-specific survival (DSS) was 21.3 months, and a plateau was observed after 5 years. The median overall survival (OS) was 13.0 months. Both MD
2
1
the median DSS and the median OS were longer for patients with stage I/II HNSCC than for patients with stage III/IV HNSCC (median DSS, not reached vs 11.4 months; P < .001; median OS, 41.9 months vs 7.9 months; P < .001). On mul-
Department of Medical Oncology, AntoineLacassagne Center, Nice, France.
tivariate analysis, stage I/II disease, treatment with curative intent, and evidence
2
of locoregional control were independent predictors of improved survival.
3
was similar to that of younger patients, and the current results indicated that age
Department of Radiotherapy, Antoine-Lacassagne Center, Canceropoˆle PACA, Nice, France. Department of Otolaryngology, Head and Neck surgery, Antoine-Lacassagne Center, Canceropoˆle PACA, Nice, France. 4
Department of Radiology, Antoine-Lacassagne Center, Canceropoˆle PACA, Nice, France.
CONCLUSIONS. The outcome of patients with stage I/II HNSCC aged 80 years should not be used to deny them optimal treatment. Elderly patients with stage III/IV HNSCC had poor survival. Geriatric tools should be used to identify elderly patients who are eligible for optimal locoregional treatment. Cancer 2008;113: 3160–8. 2008 American Cancer Society.
KEYWORDS: head and neck cancer, squamous cell carcinoma, geriatric oncology, elderly, radiotherapy, hypofractionated schedule.
A
The first 2 authors contributed equally to this article. We thank Dr Paul Barrelier for its helpful assistance. Address for reprints: Antoine Italiano, MD, Department of Medical Oncology, Antoine-Lacassagne Center, 33 Avenue de Valombrose, 06189 Nice Cedex 3, France; Fax: (011) 33 04 93 37 70 07; E-mail:
[email protected] Received May 20, 2008; revision received July 1, 2008; accepted July 21, 2008.
ª 2008 American Cancer Society
pproximately 10% of head and neck squamous cell carcinomas (HNSCC) are diagnosed in patients aged 80 years.1,2 In France, where the incidence of HNSCC is the highest by far among developed countries,2 this represents more than 1200 newly diagnosed patients per year.1 However, data on the management and outcome of very elderly patients with HNSCC are scarce and are based on small or out-of-date retrospective series and include patients who were treated during the 1960s and 1970s.3-10 Moreover, this specific population often is poorly represented in radiotherapy trials. Approximately 60% of patients who are diagnosed with HNSCC in an area that represents a population of 1300,000 inhabitants are treated in our institution. Moreover, because this area is located in the South of France, in where individuals aged 75 years represent >20% of the population (nationwide rate, 8%), our practitioners must deal with the complex management of geriatric cancer patients on a daily basis. In a first step toward alleviating the lack of a national HNSCC registry, we decided to exploit our experience,
DOI 10.1002/cncr.23931 Published online 17 October 2008 in Wiley InterScience (www.interscience.wiley.com).
HNSCC in Very Elderly Patients/Italiano et al
because it provides a unique opportunity to assess the outcome of very elderly patients with HNSCC according to the type of clinical presentation and care. To this end, in the current article, we report an extensive analysis of the data collected in our institution over the past 20 years.
MATERIALS AND METHODS Patient Population For the current study, we included all patients aged 80 years who were diagnosed with HNSCC between 1987 and 2006 and were referred to the Antoine-Lacassagne Center (Nice, France). The accuracy of all clinical data retrieved from the database was validated for each patient by 2 independent observers using the medical chart. This analysis was approved by our institutional review board. Eligible patients had primary squamous cell carcinoma (SCC) arising in the oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, paranasal sinus, or salivary glands. Patients with SCC of the skin of the head and neck, a recurrent disease, or a prior history of HNSCC were excluded from the study. In all patients, the diagnosis of SCC was verified histologically according to the World Health Organization classification of tumors.11 Because the staging system for HNSCC has undergone significant modifications during this study period, tumors were restaged based on the sixth edition of the American Joint Committee on Cancer tumor staging criteria.12 Comorbid diseases at the time of diagnosis were collected from the dataset, as described previously.13 The intentions of locoregional treatment and modalities were defined precisely in a weekly clinical multidisciplinary meeting that included at least 2 head and neck surgeons, 1 radiation oncologist, 1 medical oncologist, 1 radiologist, 1 anesthesiologist, and 1 pathologist. According to our institutional policy, curative treatment was defined as any treatment in which a complete response and prolonged remission was the objective of the medical team. Palliative treatment was defined as any treatment in which the sole intention was to improve symptoms and in which long-term survival was highly unlikely. A complete response to radiotherapy and/or chemotherapy was defined as the disappearance of all clinical and radiographic evidence of the disease. Treatment of recurrent disease was not described. Cause of death was coded according to the World Health Organization classification.14 Statistical Analysis The statistical analyses of baseline demographics and clinical outcomes were based on all data available up
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TABLE 1 Patient Characteristics (N5316) Characteristic Age at diagnosis, y Median Range Patients aged 90 y Sex Men Women PS (ECOG score) 0–1 2 Unknown No. of comorbidities
