A prospective study with Comprehensive Geriatric Assessment (CGA) before curative treatment in older patients with...

With an upward trend head and neck squamous cell carcinoma (HNSCC) patients are ageing (40% ≥ 65 years). The value of comprehensive geriatric assessment (CGA) for guiding treatment decisions in this population is not fully established. Our study prospectively assessed the influence of CGA on therapeutic strategies for elderly patients with locally advanced HNSCC .

We enrolled HNSCC patients ≥ 65 years old, stage III-IVb (AJCC 7th edition) candidated to curative treatment. Each case was discussed by a multidisciplinary team both before and after CGA. Primary objective was the proportion of therapeutic changes after CGA. Secondary aims were patients distribution into the three geriatric categories (fit, vulnerable, and frail), the accuracy of G8, recording severe toxicities and outcomes.

Between December 2017 and March 2021, 9 Italian centers enrolled 101 patients: 33.7% were fit, 39.6% vulnerable, 26.7% frail. Seventy-two patients received curative treatment. CGA prompted a change in the initial treatment plan in 12 cases (11.8%), but also led to greater attention to supportive care. 54/101experiencing at least one severe AEs. 16 patients were fit (47.1%), 21 vulnerable (52.5%) and 17 frail (63%). 30 patients required hospitalization for toxicity . At three months post-treatment evaluation, 61 of 90 patients had a complete response, while 8 had disease progression and 7 died.

CGA administration between two rounds of MDT led to changes for approximately 12% of patients and appears to help identyfing supportive care needs. Further trials are needed to specifically address the issues of older HNSCC patients.