The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era Journal Article


Authors: Zumsteg, Z. S.; Lok, B. H.; Ho, A. S.; Drill, E.; Zhang, Z.; Riaz, N.; Shiao, S. L.; Ma, J.; McBride, S. M.; Tsai, C. J.; Baxi, S. S.; Sherman, E. J.; Lee, N. Y.
Article Title: The toxicity and efficacy of concomitant chemoradiotherapy in patients aged 70 years and older with oropharyngeal carcinoma in the intensity-modulated radiotherapy era
Abstract: BACKGROUND: Despite controversy surrounding its benefit, the use of concomitant chemoradiotherapy (CCRT) in patients with oropharyngeal squamous cell carcinoma (OPSCC) who are aged > 70 years is increasing. However, to the authors' knowledge, few studies to date have compared the outcomes of different systemic treatments in this population. METHODS: Records from 74 patients aged ≥ 70 years with stage III to stage IVB OPSCC who were undergoing CCRT from 2002 to 2013 at a single institution were reviewed. Patients were stratified according to the systemic therapy received, including cisplatin, carboplatin with either 5-fluorouracil or paclitaxel (CARB), or cetuximab to compare oncologic outcome and toxicity. RESULTS: The median follow-up was 36 months. The median age of the patients was 75.3 years (range, 70-91 years), with significantly older patients receiving cetuximab (P =.03). A total of 28, 20, and 26 patients, respectively, received CCRT with cisplatin, CARB, and cetuximab. RT interruptions of > 1 day were needed in 4% of patients receiving cisplatin, 20% of patients receiving CARB, and 15% of patients receiving cetuximab (P =.19). Unplanned hospitalizations during CCRT occurred in 25%, 55%, and 58%, respectively, of patients receiving cisplatin, CARB, and cetuximab (P =.03). There were 2 treatment-related deaths, both of which occurred among the patients who were treated with cetuximab. At 5 years, locoregional control was achieved in 100%, 88%, and 60% (P<.001), respectively, and the overall survival rate was 87%, 61%, and 47% (P =.03), respectively, among patients treated with cisplatin, CARB, and cetuximab. CONCLUSIONS: Toxicity from CCRT remains a challenge for older adults with OPSCC. Herein, the authors found no evidence that this toxicity was mitigated by treatment with cetuximab. Nevertheless, a subset of patients aged ≥70 years appear to tolerate cisplatin-based treatment with acceptable toxicity and excellent outcomes. Further identification of this patient subgroup is crucial to optimize therapy for older patients with OPSCC. Cancer 2017;123:1345–1353. © 2016 American Cancer Society. © 2016 American Cancer Society
Keywords: cetuximab; elderly; chemoradiation; oropharyngeal squamous cell carcinoma; human papillomavirus (hpv)
Journal Title: Cancer
Volume: 123
Issue: 8
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2017-04-15
Start Page: 1345
End Page: 1353
Language: English
DOI: 10.1002/cncr.30495
PROVIDER: scopus
PMCID: PMC5384883
PUBMED: 27984656
DOI/URL:
Notes: Article -- Export Date: 2 May 2017 -- Source: Scopus
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MSK Authors
  1. Zhigang Zhang
    244 Zhang
  2. Eric J Sherman
    152 Sherman
  3. Nadeem Riaz
    211 Riaz
  4. Nancy Y. Lee
    550 Lee
  5. Shrujal S Baxi
    70 Baxi
  6. Benjamin H Lok
    53 Lok
  7. Esther Naomi Drill
    28 Drill
  8. Jennifer Ma
    34 Ma
  9. Sean Matthew McBride
    111 McBride
  10. Chiaojung Jillian   Tsai
    83 Tsai