Aggressive Therapy Provides Benefit in Squamous Cell Carcinoma of the Head and Neck Despite Age

Posted on April 21st, 2010 by

Age alone should not be considered the determining factor regarding aggressive treatment with multi-agent concurrent chemoradiotherapy for locally advanced head and neck squamous cell cancer, according to the results of a study presented at the Multidisciplinary Head and Neck Cancer Symposium in Chandler, Arizona, in February 2010.[1]

Multi-agent concurrent chemoradiotherapy (MCCRT) has been shown to improve survival in patients with locally advanced head and neck squamous cell cancer (HNSCC); however there has been some speculation that the treatment strategy may not be appropriate for older patients due to perceived intolerance and reduced benefit.

Researchers conducted a retrospective review of 44 patients aged 70 years or older who were treated with MCCRT between 1989 and 2007 at the Cleveland Clinic. They compared this data to a control group of 137 patients under the age of 70. Treatment included a four-day continuous infusion of fluorouracil and cisplatin during weeks one and four of daily or twice-daily radiation.

Patients in the older group were less likely to receive their second cycle of chemotherapy, with 82% receiving the chemotherapy compared with 96% in the younger group. In addition, the older patients were less likely to undergo radiation twice daily—30% of older patients underwent twice daily radiation compared with 72% of younger patients. Older patients experienced more myelosuppression and required more supportive care; however the outcomes of treatment were similar between the two groups. After a median follow-up of 62 months, the five-year disease-specific survival was 71% for older patients compared with 74% for younger patients. Freedom from recurrence was 69% in the older group and 71% in the younger group.

The researchers concluded that although the older patients experienced lower blood counts and required more supportive care, their disease-specific survival, recurrence rate, and patterns of failure were similar to younger patients. They suggest that age alone should not be deemed a contraindication to aggressive MCCRT for older patients with HNSCC.


[1] Michal SA, Adelstein DJ, Rybicki LA, et al. Multi-agent concurrent chemoradiotherapy (MCCRT) for locally advanced head and neck squamous cell cancer (HNSCC) in the elderly. Presented at the Multidisciplinary Head and Neck Cancer Symposium, February 25-27, 2010, Chandler, Arizona. Abstract # 13.


Tags: UNM CC Features

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