Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer
Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer
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DOI：
10.1016/j.amjoto.2013.07.010
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发表时间：
2013-11-01
影响因子：
2.5
通讯作者：
Chen, Allen M.
中科院分区：
文献类型：
--
作者：
Daly, Megan E.;Lau, Derick H.;Chen, Allen M.
目的：虽然同步放化疗越来越多地用于局部晚期头颈癌患者，但许多老年患者由于毒性问题而单独接受放化疗。我们评估了265岁同时接受放化疗的头颈癌患者的急性和晚期毒性。设计：回顾性审查。环境：三级保健中心。参与者：在2003年6月至2011年8月期间，连续40名265岁的患者接受了头颈癌联合放化疗。10例患者在术后接受治疗，30例接受最终放化疗。28名患者同时接受铂类化疗，12名患者同时接受每周紫杉醇治疗。治疗方案设计为提供66-72 Gy （2-2.12 Gy/分数）至确定环境或阳性边缘肿瘤总体积的95%，术后60-66 Gy （2 Gy/分数）。中位随访时间为23.2个月（范围：0-94.4个月）。主要结局指标：急性皮肤和粘膜毒性，计划外治疗中断，慢性治疗相关毒性，包括胃造口管依赖，由CTCAE v3.0分级。结果：8例（20%）患者需要放射治疗中断>= 3天。13例（33%）在治疗期间或治疗后立即需要计划外住院。未发现4+级皮肤或粘膜毒性。5例患者在bb101年仍依赖PEG管。1例患者在放化疗后3年出现下颌骨放射性骨坏死。2年Kaplan-Meier估计总生存率为55%。结论：在该队列中，因急性毒性而住院的患者比例高于预期，相应的放射治疗中断率也较高。晚期毒性率与历史对照中观察到的年轻患者相似。考虑同期放化疗治疗头颈癌的老年患者应采用谨慎的患者选择标准。(C) 2013爱思唯尔公司版权所有。
Objectives: Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age 265 who received concurrent chemoradiation for head and neck cancer.Design: Retrospective review.Setting: Tertiary care center.Participants: Between 6/2003 and 8/2011, 40 consecutive patients age 265 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66-72 Gy at 2-2.12 Gy/fraction to >95% of the gross tumor volume in the definitive setting or for positive margins and 60-66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0-94.4 months).Main outcomes measures: Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0.Results: Eight patients (20%) required a radiation treatment break of >= 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4+ skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at >1 year. One patient developed non-healing mandibular osteoradionecrosis >3 years following chemoradiation. The 2-year Kaplan-Meier estimate of overall survival was 55%.Conclusion: Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer. (C) 2013 Elsevier Inc. All rights reserved.