A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation

Rituparna Biswas; Anirban Halder; Anshuman Ghosh; Sajal Kumar Ghosh

doi:10.4103/sajc.sajc_7_18

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ORIGINAL ARTICLE: Head and Neck Cancers

08 (

); 47-51

doi:

10.4103/sajc.sajc_7_18

A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation

Rituparna Biswas¹, Anirban Halder^1,, Anshuman Ghosh¹, Sajal Kumar Ghosh¹

1 Department of Radiation Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal

*Corresponding author: Dr. Anirban Halder. dranirban666@gmail.com

Published: 2020-12-21

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Abstract

Background: Evidence suggests that older patients with oral cavity and oropharyngeal cancers may behave differently from their younger peers. Aim: The aim of this study is to determine if there is difference in responses, survival, and toxicities between young patients (≤40 years of age) with oral cavity and oropharyngeal cancers and older patients (>40 years of age) treated with concurrent chemoradiation. Materials and Methods: Sixty-one patients with unresectable, locally advanced oral cavity and oropharyngeal cancers received concomitant chemoradiation to a dose of 70 Gray in 35 fractions over 7 weeks with concomitant weekly cisplatin (40 mg/m²). These patients were then distributed in two arms. Arm-A patients having age ≤40 years and Arm-B patients having age >40 years, and the two arms were assessed for treatment outcome. Results: The overall response rate (complete responders + partial responders) evaluated using response evaluation criteria in solid tumors criteria version 1.1 was equivalent in both groups (80.76% in Arm-A and 74.28% in Arm-B; P = 0.93). Older patients (>40 years) experienced more acute mucositis and xerostomia (P < 0.5); although not statistically significant, more acute skin and pharynx toxicities were also observed in this group. Higher late salivary gland toxicity (P < 0.5) was also seen in older patients; however, disease-free survival and progression-free survival were found to be similar in both groups. Conclusions: Older patients with locally advanced oral cavity and oropharyngeal cancers have similar response rates and survival as compared to their younger counterparts but may experience higher treatment-related toxicities.

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References

Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.
Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol 2013;31:4550-9.
Lin WJ, Jiang RS, Wu SH, Chen FJ, Liu SA. Smoking, alcohol, and betel quid and oral cancer: A prospective cohort study. J Oncol 2011;2011:525976.
Brizel DM, Adelstein DJ. Locally advanced squamous carcinoma of the head and neck. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's Principles and Practices of Radiation Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 719.
Verschuur HP, Irish JC, O'Sullivan B, Goh C, Gullane PJ, Pintilie M, et al. Amatched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope 1999;109:249-58.
VanderWalde NA, Fleming M, Weiss J, Chera BS. Treatment of older patients with head and neck cancer: A review. Oncologist 2013;18:568-78.
Piantanelli L. Cancer and aging: From the kinetics of biological parameters to the kinetics of cancer incidence and mortality. Ann N Y Acad Sci 1988;521:99-109.
Lund VJ, Howard DJ. Head and neck cancer in the young: A prognostic conundrum? J Laryngol Otol 1990;104:544-8.
Amsterdam JT, Strawitz JG. Squamous cell carcinoma of the oral cavity in young adults. J Surg Oncol 1982;19:65-8.
Son YH, Kapp DS. Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale. Cancer 1985;55:441-4.
Sasaki T, Moles DR, Imai Y, Speight PM. Clinico-pathological features of squamous cell carcinoma of the oral cavity in patients <40 years of age. J Oral Pathol Med 2005;34:129-33.
von Doersten PG, Cruz RM, Rasgon BM, Quesenberry CP Jr., Hilsinger RL Jr. Relation between age and head and neck cancer recurrence after surgery: A multivariate analysis. Otolaryngol Head Neck Surg 1995;113:197-203.
Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT, et al. Presentation, treatment, and outcome of oral cavity cancer: A national cancer data base report. Head Neck 2002;24:165-80.
Gilroy JS, Morris CG, Amdur RJ, Mendenhall WM. Impact of young age on prognosis for head and neck cancer: A matched-pair analysis. Head Neck 2005;27:269-73.
Burzynski NJ, Flynn MB, Faller NM, Ragsdale TL. Squamous cell carcinoma of the upper aerodigestive tract in patients 40 years of age and younger. Oral Surg Oral Med Oral Pathol 1992;74:404-8.
Clarke RW, Stell PM. Squamous carcinoma of the head and neck in the young adult. Clin Otolaryngol 1992;17:18-23.
McGregor AD, Rennie JS. Intra-oral squamous cell carcinoma in patients under 40 years of age. A report of 13 cases and review of the literature. Br J Plast Surg 1987;40:270-3.
Pignon T, Horiot JC, Van den Bogaert W, Van Glabbeke M, Scalliet P. No age limit for radical radiotherapy in head and neck tumours. Eur J Cancer 1996;32A: 2075-81.
Allal AS, Maire D, Becker M, Dulguerov P. Feasibility and early results of accelerated radiotherapy for head and neck carcinoma in the elderly. Cancer 2000;88:648-52.

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[1] Elango JK, Gangadharan P, Sumithra S, Kuriakose MA. Trends of head and neck cancers in urban and rural India. Asian Pac J Cancer Prev 2006;7:108-12.

[2] Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol 2013;31:4550-9.

[3] Lin WJ, Jiang RS, Wu SH, Chen FJ, Liu SA. Smoking, alcohol, and betel quid and oral cancer: A prospective cohort study. J Oncol 2011;2011:525976.

[4] Brizel DM, Adelstein DJ. Locally advanced squamous carcinoma of the head and neck. In: Halperin EC, Wazer DE, Perez CA, Brady LW, editors. Perez and Brady's Principles and Practices of Radiation Oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 719.

[5] Verschuur HP, Irish JC, O'Sullivan B, Goh C, Gullane PJ, Pintilie M, et al. Amatched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope 1999;109:249-58.

[6] VanderWalde NA, Fleming M, Weiss J, Chera BS. Treatment of older patients with head and neck cancer: A review. Oncologist 2013;18:568-78.

[7] Piantanelli L. Cancer and aging: From the kinetics of biological parameters to the kinetics of cancer incidence and mortality. Ann N Y Acad Sci 1988;521:99-109.

[8] Lund VJ, Howard DJ. Head and neck cancer in the young: A prognostic conundrum? J Laryngol Otol 1990;104:544-8.

[9] Amsterdam JT, Strawitz JG. Squamous cell carcinoma of the oral cavity in young adults. J Surg Oncol 1982;19:65-8.

[10] Son YH, Kapp DS. Oral cavity and oropharyngeal cancer in a younger population. Review of literature and experience at Yale. Cancer 1985;55:441-4.

[11] Sasaki T, Moles DR, Imai Y, Speight PM. Clinico-pathological features of squamous cell carcinoma of the oral cavity in patients <40 years of age. J Oral Pathol Med 2005;34:129-33.

[12] von Doersten PG, Cruz RM, Rasgon BM, Quesenberry CP Jr., Hilsinger RL Jr. Relation between age and head and neck cancer recurrence after surgery: A multivariate analysis. Otolaryngol Head Neck Surg 1995;113:197-203.

[13] Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT, et al. Presentation, treatment, and outcome of oral cavity cancer: A national cancer data base report. Head Neck 2002;24:165-80.

[14] Gilroy JS, Morris CG, Amdur RJ, Mendenhall WM. Impact of young age on prognosis for head and neck cancer: A matched-pair analysis. Head Neck 2005;27:269-73.

[15] Burzynski NJ, Flynn MB, Faller NM, Ragsdale TL. Squamous cell carcinoma of the upper aerodigestive tract in patients 40 years of age and younger. Oral Surg Oral Med Oral Pathol 1992;74:404-8.

[16] Clarke RW, Stell PM. Squamous carcinoma of the head and neck in the young adult. Clin Otolaryngol 1992;17:18-23.

[17] McGregor AD, Rennie JS. Intra-oral squamous cell carcinoma in patients under 40 years of age. A report of 13 cases and review of the literature. Br J Plast Surg 1987;40:270-3.

[18] Pignon T, Horiot JC, Van den Bogaert W, Van Glabbeke M, Scalliet P. No age limit for radical radiotherapy in head and neck tumours. Eur J Cancer 1996;32A: 2075-81.

[19] Allal AS, Maire D, Becker M, Dulguerov P. Feasibility and early results of accelerated radiotherapy for head and neck carcinoma in the elderly. Cancer 2000;88:648-52.

A comparative study of treatment outcome in younger and older patients with locally advanced oral cavity and oropharyngeal cancers treated by chemoradiation

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Abstract

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