Findings from a recent study published in the journal CANCER show that for some older patients with locally or regionally advanced head and neck squamous cell carcinoma, the potential benefit of adding chemotherapy to radiation therapy does not outweigh the risks of this combined-modality therapy.
“Over the past 2 decades, combined-modality treatment with chemotherapy and radiation therapy has gained widespread acceptance, as numerous studies have demonstrated improved locoregional control and survival in comparison with radiation therapy alone,” Caitriona B. O’Neill, PhD, of the School of Pharmacy and Pharmaceutical Sciences at the Panoz Institute of Trinity College in Dublin, Ireland, and colleagues wrote, according to a recent news release. “Despite these advantages, the benefit of chemotherapy and radiation therapy may be offset by acute and often severe treatment-related toxicities, particularly among older patients and those with comorbid medical conditions or a poor performance status.”
In their study entitled “Treatment-related toxicities in older adults with head and neck cancer: A population-based analysis,” O’Neill and co-workers identified 2,2777 patients using the SEER–Medicare database. The patients were 66 years of age or older with a diagnosis of locally advanced neck squamous cell carcinoma, diagnosed between 2001 and 2009, and received either primary CTRT or radiation therapy (RT) alone.
Results revealed that among patients who received CTRT (n = 1502), a total of 62% experienced treatment-related toxicities, compared to a lower 46% of adverse events experienced by patients who received RT alone (n = 775). When researchers controlled for demographic and disease characteristics, the results showed that compared to patients who received RT alone, CTRT patients were twice as likely to experience an acute toxicity. Moreover, a total of 55% of patients who received CTRT had to be fed with a tube during or after treatment, compared to 28% in the RT-only group.
These results suggest that doctors could use combined-modality treatment among populations that would derive greater benefit from it. “Although the survival benefit associated with chemotherapy and radiation therapy is well established in younger patients, it is not clear whether the benefit of adding chemotherapy to radiation therapy exceeds the risk of toxicity associated with this therapy in older patients,” Dr. O’Neill and colleagues wrote. “Risk-stratified approaches may improve overall outcomes in HNSCC by directing more aggressive treatment modalities to patients with a greater likelihood of benefit and a greater ability to tolerate side effects. Such strategies would reduce the use of combined-modality therapy in those who are least likely to benefit from it and least able to tolerate it, spare them unnecessary toxicity, and reduce costs to the patient, the payer and the society at large.”