Clinical Outcome in Elderly Head and Neck Cancer Patients Treated with Concomitant Cisplatin and Radiotherapy

Cisplatin (CDDP) concomitant to radiotherapy (RT) is one of the main treatments for locally advanced head and neck squamocellular carcinoma (LA HNSCC); nevertheless, elderly patients are underrepresented in trials and frequently receive less intensive and suboptimal treatments, which often are unimodal, even if it is well demonstrated how chemoradiotherapy (CRT) with CDDP is superior to RT alone. We aim to analyze clinical feasibility in terms of acute toxicity and treatment adherence in patients receiving concurrent high-dose CDDP and RT with curative or adjuvant intent, comparing elderly (≥65 years) with young (<65 years) patients.

This is a monocentric, observational, prospective study of consecutive LA HNSCC patients treated with high dose CDDP concomitant to RT, from January 2017 to June 2024. The primary aim is to compare the performance of elderly patients with young patients in terms treatment adherence and toxicity, while the secondary aim is to assess treatment efficacy in terms of OS and PFS endpoints. The LA HNSCC patients were selected only by treatment, so all patients who did not receive chemoradiation were excluded. No difference in terms of compliance and toxicity events >G1 in the elderly versus young population is the null hypothesis. Data were analyzed using MedCal statistical software 14.12. A p < 0.05 was considered statistically significant.

A total of 170 patients were included in the study, according to the selection criteria stated. Only 7 elderly (12.3%) patients received a dose < 200 mg/m², whereas 163 patients (87.7%) received ≥ 200 mg/m² and all elderly patients completed RT, indicating a high level of adherence and effective management of treatment protocols, in front of a comparable incidence of acute toxicity to young patients (p-value: 0.84). OS and PFS were not statistically different between elderly and young patients (p = 0.20 and p = 0.72, respectively).

Our findings suggest the feasibility of curative oncological treatment for elderly individuals with LA HNSCC, if they are well selected and adequately supported. Future studies should focus on validating and expanding these results to improve patient care and outcomes.