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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 860-861

Chemoradiotherapy in older patients with squamous cell carcinoma of the head-and-neck: Is it for cure or to improve quality of life?


Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Submission29-Oct-2020
Date of Decision14-Nov-2020
Date of Acceptance15-Nov-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Jomon Raphael Chalissery
Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_343_20

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How to cite this article:
Chalissery JR. Chemoradiotherapy in older patients with squamous cell carcinoma of the head-and-neck: Is it for cure or to improve quality of life?. Cancer Res Stat Treat 2020;3:860-1

How to cite this URL:
Chalissery JR. Chemoradiotherapy in older patients with squamous cell carcinoma of the head-and-neck: Is it for cure or to improve quality of life?. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 18];3:860-1. Available from: https://www.crstonline.com/text.asp?2020/3/4/860/305007



Chemoradiotherapy with radical intent for locally advanced head-and-neck cancers is a widely discussed treatment scenario, especially in the older patients. However, there are concerns regarding the locoregional control and overall survival. Are we aiming to cure these patients of head-and-neck cancer, or do we simply want to provide a better quality of life for them? With regard to curing the disease, the post hoc analysis by Singh et al.[1] is a meticulous work derived from a well-conducted randomized trial in head-and-neck cancer.[2] Grouping of the patients according to their age and a separate analysis of the response of the older patients to treatment have been done effectively. It provides very encouraging data regarding the locoregional response in older patients (aged above 60 years). The concurrent use of chemotherapy provides information regarding the need for dose reduction in the older population for better tolerance. However, the present analysis had a limited number of patients in the older age group, thus restricting us from choosing this as a more suitable regimen for them.

As the life expectancy of the Indian population is increasing, it is high time that we think about the age grouping of older patients. Based on the GLOBOCAN data, Srinivasalu et al. in their editorial[3] have correctly pointed out the reality that the average age for patients with cancer caused by smokeless tobacco is 78 years, and this gives us very important information to reconsider our treatment strategies. The associated comorbidities in the older patients are the primary concern when choosing chemotherapy. Therefore, the authors' suggestion of the low-dose weekly carboplatin-based regimen is a good alternative for older patients.

The landmark article on chemoradiation in locally advanced head-and-neck cancer by Pignon et al.[4] clearly mentioned that there is no survival advantage for older patients. Similarly, the post hoc analysis could not show any survival benefit for this age group. If therapy cannot improve the survival, the intent should be to achieve a better quality of life without compromising the treatment protocols. This requires a patient-tailored treatment regimen. Experiences from centers that have tried customized treatment protocols using intensity-modulated radiotherapy techniques and concurrent chemotherapy regimens[5],[6] can provide better information about this aspect. Deliberate efforts should be considered to reduce the acute toxicities associated with radiation treatment and choose a chemotherapy protocol feasible with the existing comorbidities. Patients must be provided the necessary nutritional support not only during the treatment period but also in the posttreatment period until they achieve a normal routine diet to maintain their quality of life.

The post hoc analysis could have provided additional information regarding the treatment tolerance based on the type of radiotherapy used and also the impact of existing comorbidities on the overall survival of the older patients. Nutritional support is an important aspect in the treatment of older patients; it was addressed in the original randomized trial but was not accounted for in the present analysis.

An ideal regimen for older patients needs to be standardized and optimized, considering the various biological aspects of the disease, comorbidities in the patient, radiation techniques, and chemotherapeutic agents and their doses. The ultimate aim of these treatment strategies should be to maintain the quality of life and try to achieve a better overall survival.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh GK, Noronha V, Patil VM, Menon N, Joshi A, Prabhash K. Safety and efficacy of concurrent chemoradiotherapy for head-and-neck cancers in older versus younger patients: Post hoc analysis of a randomized controlled trial. Cancer Res Stat Treat 2020;3:482-8.  Back to cited text no. 1
  [Full text]  
2.
Noronha V, Joshi A, Patil VM, Agarwal J, Ghosh-Laskar S, Budrukkar A, et al. Once-a-week versus once-every-3-weeks cisplatin chemoradiation for locally advanced head and neck cancer: A Phase III randomized noninferiority trial. J Clin Oncol 2018;36:1064-72.  Back to cited text no. 2
    
3.
Srinivasalu Vijay K, Keechilat P. Does chemoradiotherapy benefit older patients with squamous cell carcinomas of the head-and-neck? Cancer Res Stat Treat 2020;3:580-2.  Back to cited text no. 3
  [Full text]  
4.
Pignon JP, Le Maître A, Maillard E, Bourhis J, MACHNC Collaborative Group. Metaanalysis of chemotherapy in head and neck cancer (MACHNC): An update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:414.  Back to cited text no. 4
    
5.
Chalissery JR, Sudheeran PC, Varghese KM, Venkatesan K. Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India. Indian J Cancer 2016;53:483-6.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Porceddu SV, Haddad RI. Management of elderly patients with locoregionally confined head and neck cancer. Lancet Oncol 2017;18:e274-83.  Back to cited text no. 6
    




 

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