Outcome of elderly patients with recurrent or metastatic head and neck cancer treated with cisplatin-based chemotherapy
Outcome of elderly patients with recurrent or metastatic head and neck cancer treated with cisplatin-based chemotherapy
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DOI：
10.1200/jco.2004.08.039
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发表时间：
2004-01-15
影响因子：
45.3
通讯作者：
Forastiere, AA
中科院分区：
文献类型：
--
作者：
Argiris, A;Li, Y;Forastiere, AA
目的评价接受姑息化疗的老年头颈部肿瘤患者的疗效。患者与方法我们分析了两个成熟的III期随机试验的数据，其中E1393比较了两个剂量水平的顺铂+紫杉醇，E1395比较了顺铂+氟尿嘧啶和顺铂+紫杉醇)，以评估70岁以上患者与年轻患者相比的毒性、客观有效率和生存期。所有患者均有未经治疗的复发或转移性头颈部鳞状细胞癌，ECOG分级为0或1。结果399名符合条件的患者中，53名老年患者入选(13%)。与年轻患者相比，老年患者的客观有效率(28%比33%)和中位进展时间(5.25比4.8个月)相似。中位生存期分别为5.3个月和8个月(Wilcoxon P=0.06；对数等级P=0.17)，1年生存率分别为26%和33%。老年患者严重肾毒性、腹泻和血小板减少的发生率明显较高。老年人中毒死亡率较高，但差异无统计学意义(13%vs8%；P=.29)。与年轻患者相比，患有复发或转移性头颈癌的Fit老年患者接受基于顺铂的双重方案的毒性增加，但有类似的生存结果。应在老年人中寻求减轻毒性的策略。
Purpose To evaluate the outcome of elderly patients with head and neck cancer undergoing palliative chemotherapy.Patients and Methods We analyzed combined data from two mature phase III randomized trials conducted by the Eastern Cooperative Oncology Group (ECOG; trial E1393, which compared cisplatin plus paclitaxel at two dose levels, and trial E1395, which compared cisplatin plus fluorouracil to cisplatin plus paclitaxel) to evaluate the toxicity, objective response rates, and survival of patients 70 years or older versus their younger counterparts. All patients had previously untreated recurrent or metastatic squamous cell carcinoma of the head and neck and ECOG performance status 0 or 1.Results Fifty-three elderly patients were enrolled from a total of 399 eligible participants (13%). Elderly patients had similar objective response rates (28% v 33%) and median time to progression (5.25 v 4.8 months) compared with younger patients. The median survival was 5.3 v 8 months (Wilcoxon P = .06; log-rank P = .17) and the 1-year survival 26% v 33% for elderly and younger patients, respectively. Elderly patients had a significantly higher incidence of severe nephrotoxicity, diarrhea, and thrombocytopenia. A higher rate of toxic deaths was noted in the elderly but did not reach statistical significance (13% v 8%; P = .29).Conclusion Elderly patients were underrepresented in these studies. Fit elderly patients with recurrent or metastatic head and neck cancer sustained increased toxicities with cisplatin-based doublets but had comparable survival outcomes compared with younger patients. Strategies to ameliorate toxicities should be pursued in the elderly.