European Archives of Oto-Rhino-Laryngology

, Volume 272, Issue 3, pp 719–725 | Cite as

Radiotherapy for head and neck cancer in nonagenarian patients: a possible cornerstone?

  • Romain Rivoirard
  • Coralie Moncharmont
  • Avi Assouline
  • Pierre Auberdiac
  • Benoite Mery
  • Alexander Tuan Falk
  • Pierre Annède
  • Jane-Chloé Trone
  • Jean-Baptiste Guy
  • Nicolas Vial
  • Pierre Fournel
  • Yacine Merrouche
  • Cyrus Chargari
  • Nicolas Magné
Head and Neck

Abstract

In the field of radiotherapy, there is very little scientific data on the management of nonagenarians, especially in patients aged 90 years or more and with head and neck cancer (HNC). We made one of the first retrospective study of the feasibility and safety of radiotherapy in this population with HNC. Records of radiotherapy coming from four health facilities were studied to include all nonagenarian patients with HNC in the last 10 years and who received radiation therapy. We analyzed patient characteristics and primary cancers, as well as objective of the treatment (curative or palliative), efficacy and toxicity. Twenty patients receiving radiotherapy were identified; mean age was 93.2 years (standard deviation 2.8). Treatment was given with curative and palliative intent in 40 and 60 % of cases, respectively. The most common primary tumors were tumors of the salivary glands (30 % of cases), oral cavity tumors (25 % of cases) and thyroid tumors (15 % of cases). Median total prescribed dose was 47.5 Gy (12–70 Gy). Median number of delivered fractions was 18.5 (2–35 fractions). All patients received intensive supportive care during radiotherapy. Toxicities were mild to moderate. Radiotherapy could not be completed for four patients (20 % of cases). One patient developed grade 1–2 delayed toxicities. At the last follow-up, only four patients (20 % of cases) were alive. Cancer was cause of death in most cases. Radiotherapy may be performed for the nonagenarians with HNC. The total dose and fractionation must be adjusted to optimize the tolerance. However, the prognosis remains very poor, cancer being the main cause of death. Research of geriatric vulnerabilities prior to any treatment, in the context of a comprehensive geriatric assessment, is still recommended to select patients for radiotherapy.

Keywords

Head and neck cancer Nonagenarian Radiotherapy 

Notes

Acknowledgments

We wish to acknowledge and thank all of the study participants.

Conflict of interest

The authors have no conflict of interest.

References

  1. 1.
    Adveev A, Eremenko T, Festy P, Gaymu J, Le Bouteillec N, Springer S (2011) Populations and Demographic Trends of European Countries (1980–2010). Population 66:9–130Google Scholar
  2. 2.
    Lafortune G, De Looper M, Balestat G et al (2009) Health at a glance 2009: OECD indicators. OECD Publishing, ParisGoogle Scholar
  3. 3.
    United Nations, Department of Economic and Social Affairs, Population Division, Population Estimates and Projections Section. World Population Prospects, the 2010 Revision. Population by age groups—both sexes. Estimates, 1950–2010. [cited 23/05/2013]. Available from http://esa.un.org/wpp/Excel-Data/population.htm. Accessed 1 Nov 2013
  4. 4.
    United Nations, Department of Economic and Social Affairs, Population Division, Population Estimates and Projections Section. World Population Prospects, the 2010 Revision. Population by Age Groups-Both Sexes. Medium-fertility variant, 2010–2100 [cited 23/05/2013]. Available from http://esa.un.org/wpp/Excel-Data/population.htm. Accessed 1 Nov 2013
  5. 5.
    Institut National du Cancer, The situation of cancer in France in 2010:87 [cited 14/7/2013]Available from http://www.e-cancer.fr/en/publications/69-epidemiologie/573-la-situation-du-cancer-en-france-en-2010 (in French). Accessed 1 Nov 2013
  6. 6.
    World Health Organization. International Agency for Research on Cancer (IARC) website [cited 14/7/2013]. Available from http://www-dep.iarc.fr/. Accessed 1 Nov 2013
  7. 7.
    Italiano A, Ortholan C, Dassonville O et al (2008) Head and neck squamous cell carcinoma in patients aged ≥80 years: patterns of care and survival. Cancer 113:3160–3168CrossRefPubMedGoogle Scholar
  8. 8.
    Ortholan C, Benezery K, Dassonville O, Poissonnet G, Bozec A, Guiochet N, Belkacemi Y (2011) A specific approach for elderly patients with head and neck cancer. Anticancer Drugs 22:647–655CrossRefPubMedGoogle Scholar
  9. 9.
    Lalami Y, de Castro G, Bernard-Marty C Jr, Awada A (2009) Management of head and neck cancer in elderly patients. Drugs Aging 26:571–583CrossRefPubMedGoogle Scholar
  10. 10.
    Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP (2007) Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol 14:1449–1457CrossRefPubMedGoogle Scholar
  11. 11.
    Haque R, Contreras R, McNicoll MP, Eckberg EC, Petitti DB (2006) Surgical margins and survival after head and neck cancer surgery. BMC Ear Nose Throat Disord 17(6):2CrossRefGoogle Scholar
  12. 12.
    Jones AS, Bin Hanafi Z, Nadapalan V et al (1996) Do positive resection margins after ablative surgery for head and neck cancer adversely affect prognosis? A study of 352 patients with recurrent carcinoma following radiotherapy treated by salvage surgery. Br J Cancer 74:128–132CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Hirano M, Ohkubo H, Kurita S, Hirade Y (1988) Preservation surgery of head and neck cancer. Results and postsurgical function. Gan To Kagaku Ryoho 15:881–886 (in Japanese)PubMedGoogle Scholar
  14. 14.
    Sesterhenn AM, Schotte TL, Bauhofer A et al (2011) Head and neck cancer surgery in the elderly: outcome evaluation with the McPeek score. Ann Otol Rhinol Laryngol 120:110–115CrossRefPubMedGoogle Scholar
  15. 15.
    Sesterhenn AM, Teymoortash A, Folz BJ, Werner JA (2005) Head and neck cancer in the elderly: a cohort study in 40 patients. Acta Oncol 44:59–64CrossRefPubMedGoogle Scholar
  16. 16.
    Vermorken JB, Remenar E, van Herpen C et al (2007) EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 357:1695–1704CrossRefPubMedGoogle Scholar
  17. 17.
    Posner MR, Hershock DM, Blajman CR et al (2007) Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 357:1705–1715CrossRefPubMedGoogle Scholar
  18. 18.
    Pointreau Y, Garaud P, Chapet S et al (2009) Randomized trial of induction chemotherapy with cisplatin and 5-fluorouracil with or without docetaxel for larynx preservation. J Natl Cancer Inst 101:498–506CrossRefPubMedGoogle Scholar
  19. 19.
    Pignon JP, le Maître A, Maillard E, Bourhis J (2009) MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14CrossRefPubMedGoogle Scholar
  20. 20.
    Browman GP, Hodson DI, Mackenzie RJ, Bestic N, Zuraw L (2001) Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: a systematic review of the published literature with subgroup analysis. Head Neck 23:579–589CrossRefPubMedGoogle Scholar
  21. 21.
    Bernier J, Domenge C, Ozsahin M et al (2004) European Organization for Research and Treatment of Cancer Trial 22931. postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMedGoogle Scholar
  22. 22.
    Cooper JS, Pajak TF, Forastiere AA et al (2004) Radiation Therapy Oncology Group9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944CrossRefPubMedGoogle Scholar
  23. 23.
    Bernardi D, Barzan L, Franchin G et al (2005) Treatment of head and neck cancer in elderly patients: state of the art and guidelines. Crit Rev Oncol Hematol 53:71–80CrossRefPubMedGoogle Scholar
  24. 24.
    Kogashiwa Y, Nagafuji H, Kohno N (2012) Feasibility of concurrent chemoradiotherapy with S-1 administered on alternate days for elderly patients with head and neck cancer. Anticancer Res 32:4035–4040PubMedGoogle Scholar
  25. 25.
    Nguyen NP, Vock J, Chi A et al (2012) Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol 188:677–683CrossRefPubMedGoogle Scholar
  26. 26.
    Kramer S, Gelber RD, Snow JB et al (1987) Combined radiation therapy and surgery in the management of advanced head and neck cancer: final report of study 73-03 of the radiation therapy oncology group. Head Neck Surg 10:19–30CrossRefPubMedGoogle Scholar
  27. 27.
    Vikram B, Strong EW, Shah JP, Spiro R (1984) Failure at the primary site following multimodality treatment in advanced head and neck cancer. Head Neck Surg 6:720–723CrossRefPubMedGoogle Scholar
  28. 28.
    Corry J, Peters LJ, Costa ID et al (2005) The ‘QUAD SHOT’–a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiother Oncol 77:137–142CrossRefPubMedGoogle Scholar
  29. 29.
    Mohanti BK, Umapathy H, Bahadur S, Thakar A, Pathy S (2004) Short course palliative radiotherapy of 20 Gy in 5 fractions for advanced and incurable head and neck cancer: AIIMS study. Radiother Oncol 71:275–280CrossRefPubMedGoogle Scholar
  30. 30.
    Donato V, Valeriani M, Zurlo A (2003) Short course radiation therapy for elderly cancer patients. Evidences from the literature review. Crit Rev Oncol Hematol 45:305–311CrossRefPubMedGoogle Scholar
  31. 31.
    Chargari C, Moriceau G, Auberdiac P et al (2014) Feasibility of radiation therapy in patients 90 years of age and older: a French multicentre analysis. Eur J Cancer. doi: 10.1016/j.ejca.2014.02.012
  32. 32.
    Horiot JC (2007) Radiation therapy and the geriatric oncology patient. J Clin Oncol 25:1930–1935CrossRefPubMedGoogle Scholar
  33. 33.
    Mitsuhashi N, Hayakawa K, Yamakawa M et al (1999) Cancer in patients aged 90 years or older: radiation therapy. Radiology 211:829–833CrossRefPubMedGoogle Scholar
  34. 34.
    Ikeda H, Ishikura S, Oguchi M et al (1999) Analysis of 57 nonagenarian cancer patients treated by radical radiotherapy: a survey of eight institutions. Jpn J Clin Oncol 29:378–381CrossRefPubMedGoogle Scholar
  35. 35.
    Oguchi M, Ikeda H, Watanabe T et al (1998) Experiences of 23 patients ≥90 years of age treated with radiation therapy. Int J Radiat Oncol Biol Phys 41:407–413CrossRefPubMedGoogle Scholar
  36. 36.
    Wasil T, Lichtman SM, Gupta V, Rush S (2000) Radiation therapy in cancer patients 80 years of age and older. Am J Clin Oncol 23:526–530CrossRefPubMedGoogle Scholar
  37. 37.
    Hoffman HT, Karnell LH, Funk GF, Robinson RA, Menck HR (1998) The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg 124:951–962CrossRefPubMedGoogle Scholar
  38. 38.
    Arenal JJ, Tinoco C, Labarga F, Martínez R, Gonzalo M (2012) Colorectal cancer in nonagenarians. Colorectal Dis 14:44–47CrossRefPubMedGoogle Scholar
  39. 39.
    Damhuis RA, Meurs CJ, Meijer WS (2005) Postoperative mortality after cancer surgery in octogenarians and nonagenarians: results from a series of 5,390 patients. World J Surg Oncol 3:71CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Hurria A (2006) We need a geriatric assessment for oncologists. Nat Clin Pract Oncol 3:642–643CrossRefPubMedGoogle Scholar
  41. 41.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  42. 42.
    Bellera CA, Rainfray M, Mathoulin-Pélissier S et al (2012) Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol 23:2166–2172CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Romain Rivoirard
    • 1
  • Coralie Moncharmont
    • 2
  • Avi Assouline
    • 3
  • Pierre Auberdiac
    • 4
  • Benoite Mery
    • 1
  • Alexander Tuan Falk
    • 5
  • Pierre Annède
    • 6
  • Jane-Chloé Trone
    • 2
  • Jean-Baptiste Guy
    • 2
  • Nicolas Vial
    • 2
  • Pierre Fournel
    • 1
  • Yacine Merrouche
    • 1
  • Cyrus Chargari
    • 6
  • Nicolas Magné
    • 2
  1. 1.Department of Medical OncologyInstitut Lucien NeuwirthSt Priest en Jarez CedexFrance
  2. 2.Département de RadiothérapieInstitut de Cancérologie Lucien NeuwirthSt Priest en Jarez cedexFrance
  3. 3.Department of RadiotherapyClinical Center of Porte de Saint CloudBoulogne-BillancourtFrance
  4. 4.Department of RadiotherapyClinique Claude BernardAlbiFrance
  5. 5.Department of RadiotherapyCentre Antoine LacassagneNiceFrance
  6. 6.Department of RadiotherapyInstruction Armed Val-de-Grace HospitalParisFrance

Personalised recommendations