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Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer

Bedeutung der intensitätsmodulierten und bildgestützten Strahlentherapie für die Radiochemotherapie lokal fortgeschrittener HNO-Tumoren älterer Patienten

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Abstract

Purpose

In this work, the treatment tolerance of elderly patients (≥70 years) undergoing intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) and chemotherapy for locally advanced head and neck cancer was assessed.

Patients and methods

A retrospective review of 112 patients undergoing concurrent chemoradiation for locally advanced head and neck cancer was performed. Treatment toxicity, protocol violations, long-term complications, and survival were compared between 85 younger patients (< 70 years) and 27 older patients (≥ 70 years).

Results

Grade 3–4 treatment toxicity was observed in 88.2% and 88.8% for younger and older patients, respectively. Mean weight loss and treatment break were 5.9 and 3.9 kg (p = 0.03) and 7.3 and 7.8 days (p = 0.8) for younger and older patients, respectively. Seven patients (8.2%) did not complete treatment in the younger group compared to 1 patient (3.7%) in the older group (p = 0.6). No significant differences in protocol violations and survival were found between the two groups.

Conclusion

Compared to younger patients, elderly patients with locally advanced head and neck cancer tolerated chemoradiation with IMRT and IGRT well, and should not be denied curative treatment based solely on age.

Zusammenfassung

Ziel

In dieser Arbeit wurde die Behandlungstoleranz älterer Patienten (≥70 Jahre) mit lokal fortgeschrittenen HNO-Tumoren, die mit intensitätsmodulierter (IMRT) oder bildgestützter Strahlentherapie (IGRT) und Chemotherapie behandelt werden, untersucht.

Patienten und Methoden

Es wurde eine retrospektive Analyse der Daten von 112 Patienten mit lokal fortgeschrittenen HNO-Tumoren, die gleichzeitig mittels Radiochemotherapie behandelt wurden, durchgeführt. Akuttoxizität, Protokollverletzungen, Langzeittoxizität und Überleben wurden zwischen 85 jüngeren Patienten (<70 Jahren) und 27 älteren Patienten (≥70 Jahre) verglichen.

Ergebnisse

Akute Therapietoxizität vom Grad 3–4 trat bei 88,2% der jüngeren Patienten und bei 88,8% der älteren Patienten auf. Der mittlere Gewichtsverlust betrug 5,9 kg bzw. 3,9 kg (p = 0,03). Die mittlere Dauer der Therapieunterbrechungen lag bei 7,3 bzw. 7,8 Tagen (p = 0,8) für die jüngeren bzw. älteren Patienten. Bei 7 Patienten (8,2%) der jüngeren Gruppe und einem Patienten (3,7%) der älteren Gruppe musste die Behandlung vorzeitig abgebrochen werden. Zwischen den beiden Gruppen fand sich kein signifikanter Unterschied bezüglich Protokollverletzungen und Überleben.

Schlussfolgerung

Im Vergleich zu jüngeren Patienten tolerierten ältere Patienten mit lokal fortgeschrittenen HNO-Karzinomen die Radiochemotherapie mit IMRT und IGRT gut und sollten nicht allein aufgrund ihres Alters von einer kurativen Behandlung ausgeschlossen werden.

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Conflict of interest

On behalf of all authors, the corresponding author states the following: the authors have no conflicts of interest and have no source of funding.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Arizona, 1501 N Campbell Ave, 85724-5081, Tucson, AZ, USA

    N.P. Nguyen M.D., A. Chi, L. Ewell, F. Almeida, M. Miller, R. Davis & T. Sroka

  2. Department of Radiation Oncology, University of Bern, Bern, Switzerland

    J. Vock

  3. Department of Radiation Oncology, University Hospitals of Geneva, Geneva, Switzerland

    V. Vinh-Hung & M. Betz

  4. Department of Radiation Oncology, San Antonio Cancer Center, San Antonio, TX, USA

    S. Dutta

  5. Department of Radiation Oncology, University of Pittsburg, Pittsburg, PA, USA

    S. Jang

  6. University of Galveston Medical School, Galveston, TX, USA

    R.P. Vo

  7. Department of Radiation Oncology, Marshfield Clinic, Marshfield, WI, USA

    U. Karlsson

  8. Department of Biostatistics, East Carolina University, Greenville, NC, USA

    P. Vos

Authors
  1. N.P. Nguyen M.D.
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  2. J. Vock
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  3. A. Chi
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  4. V. Vinh-Hung
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  5. S. Dutta
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  6. L. Ewell
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  7. S. Jang
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  8. M. Betz
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  9. F. Almeida
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  10. M. Miller
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  11. R. Davis
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  12. T. Sroka
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  13. R.P. Vo
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  14. U. Karlsson
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  15. P. Vos
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Corresponding author

Correspondence to N.P. Nguyen M.D..

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Nguyen, N., Vock, J., Chi, A. et al. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol 188, 677–685 (2012). https://doi.org/10.1007/s00066-012-0125-0

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  • DOI: https://doi.org/10.1007/s00066-012-0125-0

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