Premium
Use of systemic therapy with definitive radiotherapy for elderly patients with head and neck cancer: A National Cancer Data Base analysis
Author(s) -
Ward Matthew C.,
Reddy Chandana A.,
Adelstein David J.,
Koyfman Shlomo A.
Publication year - 2016
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30214
Subject(s) - medicine , systemic therapy , radiation therapy , hazard ratio , head and neck cancer , confidence interval , cancer , proportional hazards model , larynx , surgery , multivariate analysis , carcinoma , oncology , breast cancer
BACKGROUND The purpose of this study was to investigate the use of systemic therapy along with definitive radiotherapy for elderly patients with head and neck cancer. METHODS Patients who were 71 years old or older with stage III to IVB squamous cell carcinoma of the nasopharynx, oropharynx, larynx, or hypopharynx treated with definitive radiotherapy with or without systemic therapy were identified from the National Cancer Data Base. Patterns of systemic therapy use before or during definitive radiotherapy were investigated. The association between systemic therapy use and overall survival was investigated with a multivariate, inverse probability–weighted propensity score–adjusted Cox proportional hazards model. RESULTS Elderly patients treated between 2004 and 2012 (n = 4165) were identified, and 80.4% received systemic therapy. The median follow‐up was 26 months (range, 1.8‐125 months), and the 3‐year overall survival rate was 51.6% (95% confidence interval, 50.0%‐53.2%). During the study period, there was an increase in the frequency of systemic therapy use from 64% in 2004 to 86% in 2012. The use of systemic therapy was associated with improved overall survival in the multivariate model (hazard ratio, 1.456; 95% confidence interval, 1.308‐1.620; P < .0001). A threshold age above which the use of systemic therapy was not associated with improved overall survival in select patients was not identified. CONCLUSIONS In contrast to the available prospective evidence, the majority of elderly patients with locoregionally advanced head and neck cancer treated with definitive radiotherapy also receive systemic therapy. The use of systemic therapy is associated with improved overall survival and should be a patient‐specific decision in all age groups. Cancer 2016;122:3472–3483 . © 2016 American Cancer Society