How to increase the chance of survival in older patients with head and neck cancer (Do both radiotherapy and chemotherapy)

Medical Xpress / Leipzig University / JAMA Network Open ^ | April 26, 2023 | Alexander Rühle et al

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Should patients over the age of 70 with head and neck cancer receive aggressive combined radiotherapy and chemotherapy? This is a controversial issue. A large-scale international study proves the effectiveness of this combined treatment in older patients.

Compared to younger patients, cancer treatment is highly individualized due to more frequent and sometimes severe comorbidities, increasing age-related infirmities and reduced physical fitness. It is also important to consider the side effects of treatment, which can affect quality of life.

The standard treatment for head and neck cancer is either surgical removal of the tumor followed by radiotherapy, or organ-preserving radiotherapy in combination with chemotherapy. The use of concomitant chemotherapy is particularly controversial because of the physical strain and side effects in older patients.

An international study involving twelve university hospitals in Europe and the U.S. has investigated the extent to which older head and neck cancer patients benefit from a combination of radiotherapy and chemotherapy on the one hand, or an alternative drug therapy with an antibody against a growth factor receptor (EGFR) on the other. This clinical study shows adding chemotherapy to radiotherapy is associated with a better chance of survival compared to radiotherapy alone. This benefit was particularly pronounced in patients between 65 and 79 years of age and in those with good general health and few comorbidities.

"Fit older patients with minor comorbidities should not be denied this effective therapy simply because of their advanced age," explains Professor Nils Nicolay. "In contrast, radiotherapy combined with taking the growth factor antibody showed no survival benefit compared to radiotherapy alone."

The researchers analyzed data from 1,044 older patients with head and neck squamous cell carcinoma of the oral cavity, pharynx or larynx who were treated with radiotherapy and, in some cases, in combination with a drug between 2005 and 2019.

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