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Besonderheiten der Strahlentherapie beim alten Kopf-Hals-Tumor-Patienten

Special features of radiotherapy in older patients with head and neck cancer

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Demografische Veränderungen stellen Anforderungen an die Behandlung von alten Menschen mit Kopf-Hals-Tumoren (KHT). Viele KHT-Patienten unterziehen sich einer Strahlentherapie (RT).

Material und Methoden

Die Informationen basieren auf einer PubMed-Recherche und Fachliteratur.

Ergebnisse

Alte KHT-Patienten haben, bei geringer Komorbidität, ein mit jüngeren Patienten vergleichbares Therapie-Outcome. Die Kombinationstherapie ist bezüglich des Überlebens der alleinigen RT überlegen. Es kann keine Altersgrenze für Kombinationstherapien festgelegt werden. Es liegen nur vergleichende Analysen aus Datenbanken vor. Bei reduziertem Allgemeinzustand (AZ) muss dezidiert überlegt werden, welche Behandlungsoptionen die Situation des Patienten verbessern. Eine Behandlung sollte nicht um jeden Preis erfolgen. Die interdisziplinäre Erarbeitung einer Therapiezieländerung (Best Supportive Care) ist für Patienten hilfreich.

Schlussfolgerung

Alte Menschen mit KHT in gutem AZ sollten mit einer Kombinationstherapie behandelt werden. Für Patienten in schlechtem AZ muss eine höchstindividuelle, interdisziplinäre Behandlungskonzeption erarbeitet werden.

Abstract

Background

Demographic changes represent challenges for the treatment of older patients with head and neck cancer (HNC). Many HNC patients undergo radiotherapy (RT).

Material and methods

The review is based on a PubMed search and specialist literature.

Results

Older HNC patients with a low comorbidity index have a comparable treatment outcome to younger patients. Combined treatment improves survival compared to RT alone. An age limit for combination treatment cannot be fixed. There are only comparative analyses based on different databases. For patients with a reduced general physical condition, consideration must be given as to which treatment option would improve the situation. Treatment should not be carried out at all costs. Choosing wisely is helpful for patients in detrimental situations. Best supportive care is also an option.

Conclusion

Older HNC patients in a good general condition should be treated by a combined treatment modality. For patients in a reduced general condition choose wisely with the help of an interdisciplinary team.

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Literatur

  1. Amini A, Jones BL, Mcdermott JD et al (2016) Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base. Cancer 122:1533–1543

    Article  PubMed  Google Scholar 

  2. Arends J, Baracos V, Bertz H et al (2017) ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr 36:1187–1196

    Article  CAS  PubMed  Google Scholar 

  3. Barnes B, Kraywinkel K, Nowossadeck E et al (2016) Bericht zum Krebsgeschehen in Deutschland 2016. https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebsgeschehen/Krebsgeschehen_download.pdf?__blob=publicationFile

    Google Scholar 

  4. Beadle BM, Liao KP, Elting LS et al (2014) Improved survival using intensity-modulated radiation therapy in head and neck cancers: a SEER-Medicare analysis. Cancer 120:702–710

    Article  PubMed  Google Scholar 

  5. Bellera CA, Rainfray M, Mathoulin-Pelissier S et al (2012) Screening older cancer patients: first evaluation of the G‑8 geriatric screening tool. Ann Oncol 23:2166–2172

    Article  CAS  PubMed  Google Scholar 

  6. Biganzoli L, Boni L, Becheri D et al (2013) Evaluation of the cardiovascular health study (CHS) instrument and the Vulnerable Elders Survey-13 (VES-13) in elderly cancer patients. Are we still missing the right screening tool? Ann Oncol 24:494–500

    Article  CAS  PubMed  Google Scholar 

  7. Bozzetti F (2019) Nutritional intervention is indicated in malnourished cancer patients. Clin Nutr 38:477

    Article  PubMed  Google Scholar 

  8. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  PubMed  Google Scholar 

  9. Hurria A, Dale W, Mooney M et al (2014) Designing therapeutic clinical trials for older and frail adults with cancer: U13 conference recommendations. J Clin Oncol 32:2587–2594

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kellen E, Bulens P, Deckx L et al (2010) Identifying an accurate pre-screening tool in geriatric oncology. Crit Rev Oncol Hematol 75:243–248

    Article  PubMed  Google Scholar 

  11. Kenis C, Bron D, Libert Y et al (2013) Relevance of a systematic geriatric screening and assessment in older patients with cancer: results of a prospective multicentric study. Ann Oncol 24:1306–1312

    Article  CAS  PubMed  Google Scholar 

  12. Kenis C, Decoster L, Van Puyvelde K et al (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32:19–26

    Article  Google Scholar 

  13. Kim SA, Roh JL, Lee SA et al (2016) Pretreatment depression as a prognostic indicator of survival and nutritional status in patients with head and neck cancer. Cancer 122:131–140

    Article  CAS  PubMed  Google Scholar 

  14. Lee JH, Ba D, Liu G et al (2019) Association of head and neck cancer with mental health disorders in a large insurance claims database. JAMA Otolaryngol Head Neck Surg 145(4):339. https://doi.org/10.1001/jamaoto.2018.4512

    Article  PubMed  Google Scholar 

  15. Luciani A, Ascione G, Bertuzzi C et al (2010) Detecting disabilities in older patients with cancer: comparison between comprehensive geriatric assessment and vulnerable elders survey-13. J Clin Oncol 28:2046–2050

    Article  PubMed  Google Scholar 

  16. Machtay M, Moughan J, Trotti A et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Mercadante S, Casuccio A, Pumo S et al (2000) Factors influencing the opioid response in advanced cancer patients with pain followed at home: the effects of age and gender. Support Care Cancer 8:123–130

    Article  CAS  PubMed  Google Scholar 

  18. Mislang AR, Di Donato S, Hubbard J et al (2018) Nutritional management of older adults with gastrointestinal cancers: An International Society of Geriatric Oncology (SIOG) review paper. J Geriatr Oncol 9:382–392

    Article  PubMed  Google Scholar 

  19. Mohile SG, Bylow K, Dale W et al (2007) A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation. Cancer 109:802–810

    Article  PubMed  Google Scholar 

  20. Molina-Garrido MJ, Guillen-Ponce C (2011) Comparison of two frailty screening tools in older women with early breast cancer. Crit Rev Oncol Hematol 79:51–64

    Article  CAS  PubMed  Google Scholar 

  21. Owusu C, Koroukian SM, Schluchter M et al (2011) Screening older cancer patients for a comprehensive geriatric assessment: a comparison of three instruments. J Geriatr Oncol 2:121–129

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pignon JP, Auperin A, Borget I et al (2009) Role of meta-analyses and of large randomized trials in the study of cancer treatments. Lung Cancer 65:9–12

    Article  PubMed  Google Scholar 

  23. Rockwood K, Song X, MacKnight C et al (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ 173(5):489–495. https://doi.org/10.1503/Fcmaj.050051

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rubenstein LZ, Applegate WB, Burton JR et al (1991) Medicare reimbursement for geriatric assessment: report of the American Geriatrics Society Ad Hoc Committee on Geriatrics Assessment. J Am Geriatr Soc 39:926–931

    Article  CAS  PubMed  Google Scholar 

  25. Saliba D, Elliott M, Rubenstein LZ et al (2001) The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc 49:1691–1699

    Article  CAS  Google Scholar 

  26. Straube C, Pigorsch SU, Scherb H et al (2016) Reduced volume SIB-IMRT/IGRT to head and neck cancer in elderly and frail patients: outcome and toxicity. Radiat Oncol 11:133

    Article  PubMed  PubMed Central  Google Scholar 

  27. Unger JM, Vaidya R, Hershman DL et al (2019) Systematic review and Meta-analysis of the magnitude of structural, clinical, and physician and patient barriers to cancer clinical trial participation. J Natl Cancer Inst 111:245–255

    Article  PubMed  PubMed Central  Google Scholar 

  28. Van Der Schroeff MP, Derks W, Hordijk GJ et al (2007) The effect of age on survival and quality of life in elderly head and neck cancer patients: a long-term prospective study. Eur Arch Otorhinolaryngol 264:415–422

    Article  PubMed  Google Scholar 

  29. Vanderwalde NA, Meyer AM, Deal AM et al (2014) Effectiveness of chemoradiation for head and neck cancer in an older patient population. Int J Radiat Oncol Biol Phys 89:30–37

    Article  PubMed  Google Scholar 

  30. Ward MC, Reddy CA, Adelstein DJ et al (2016) Use of systemic therapy with definitive radiotherapy for elderly patients with head and neck cancer: A National Cancer Data Base analysis. Cancer 122:3472–3483

    Article  PubMed  Google Scholar 

  31. Zaorsky NG, Zhang Y, Tuanquin L et al (2019) Suicide among cancer patients. Nat Commun 10:207

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Deutschland

    Steffi U. Pigorsch

  2. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Deutschland

    Victor Lewitzki

Authors
  1. Steffi U. Pigorsch
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  2. Victor Lewitzki
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Corresponding author

Correspondence to Steffi U. Pigorsch.

Ethics declarations

Interessenkonflikt

S.U. Pigorsch und V. Lewitzki geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Pigorsch, S.U., Lewitzki, V. Besonderheiten der Strahlentherapie beim alten Kopf-Hals-Tumor-Patienten. Onkologe 25, 784–795 (2019). https://doi.org/10.1007/s00761-019-0588-z

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  • DOI: https://doi.org/10.1007/s00761-019-0588-z

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