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LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 862-863

Authors' reply to Dhanushkodi et al. and Chalissery


Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission24-Nov-2020
Date of Decision30-Nov-2020
Date of Acceptance04-Dec-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_356_20

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How to cite this article:
Singh GK, Noronha V, Patil VM, Menon N, Joshi A, Prabhash K. Authors' reply to Dhanushkodi et al. and Chalissery. Cancer Res Stat Treat 2020;3:862-3

How to cite this URL:
Singh GK, Noronha V, Patil VM, Menon N, Joshi A, Prabhash K. Authors' reply to Dhanushkodi et al. and Chalissery. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 26];3:862-3. Available from: https://www.crstonline.com/text.asp?2020/3/4/862/305015



We thank Dhanushkodi et al.[1] and Raphael[2] for their interest in our article[3] and Srinivasalu and Pavithran[4] for the accompanying editorial with salient comments. The baseline audiometry information was erroneously entered in the patient demographics table. All patients in the study[5] had undergone an audiometry examination before starting therapy.

We agree that the younger and older patients both had similar Grade 3 and 4 toxicities, and the reason could be the greater dose reductions in the older patients. Mohile et al. observed that baseline geriatric assessment and intervention can reduce the Grade 3 and 4 treatment-related toxicities in older patients. Grade 3 or 4 toxicities were seen in 50.1% of the older patients with cancer who underwent geriatric assessment-directed interventions versus 71% of those who received the standard treatment.[6] Hence, the reduced toxicities can be attributed to the compromised dose intensity.[6] Although baseline geriatric assessment and guided therapy were not performed in our study, according to the study protocol, we were liberal in dose reduction in patients who experienced severe toxicities.

We are unsure about the reason for higher rates of Grade 3 and 4 odynophagia in the older patients; this could be attributed to the relatively smaller size of the older cohort.

As part of the study protocol, we performed swallowing and nutritional assessments at baseline for all the patients. As correctly pointed out, none of our patients had Grade 3 weight loss despite 63.4% of patients requiring feeding tube insertion. We meticulously assessed the nutritional status in all the patients during chemoradiotherapy and during the post-treatment period, apart from the baseline assessments. A team of nutritionists and speech and swallowing experts worked in parallel along with the treating oncologists. We proactively advised feeding tube insertion in nutritionally compromised patients and in those with dysphagia or odynophagia, in addition to the patients with weight loss. Accordingly, patients with Grade 3 weight loss, dysphagia, odynophagia, and oral mucositis, where oral intake was difficult, were supported with feeding tube insertion and advised enteral nutrition. We found that there was no significant difference in the requirement for feeding tube insertion between the younger and older patients.

In a recent study presented at the American Society of Clinical Oncology 2020, Kiyota et al. showed noninferiority of weekly cisplatin (40 mg/m2) compared to 3-weekly cisplatin (100 mg/m2) concurrently with radical radiation for patients with locally advanced head-and-neck squamous cell carcinoma.[7] Although there are many possible reasons why the results of this study appear to be contradictory to those of our earlier study,[5] including the dose of cisplatin, the type of patients enrolled in the study, the primary site of disease, etc., we await the full-text publication of this study to help us better understand the optimal concurrent cisplatin regimen with radical radiotherapy.

We completely agree that quality of life (QOL) is of paramount importance in older patients. There was no significant difference observed in toxicities among the two groups (younger vs. older). Only one patient in our study received intensity-modulated radiation therapy, while the others were treated with conventional radiation techniques.[5] Hence, the effect of radiation technique on the toxicities cannot be commented upon.

We did not use a weighted comorbidity scale such as the Cumulative Illness Rating Scale-Geriatric for the assessment of comorbidities in the patients in our study, and hence, commenting on the impact of comorbidity would be difficult too. Overall, 7 out of 17 (41.2%) older patients and 75 out of 283 (26.5%) younger patients had comorbidities; however, the difference was not statistically significant (P = 0.15).

We would like to reiterate that patients with head-and-neck cancers should not be denied radical -intent concurrent chemoradiation merely on the basis of chronological age. Geriatric assessment and guided management approach can help in reducing the treatment-related toxicities and improving the QOL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dhanushkodi M, Vaidhyalingam V, Krishnamurthy A. Should we add chemotherapy to radiation therapy in older adults with locally advanced head and neck squamous cell carcinoma? Cancer Res Stat Treat 2020;3:859-60.  Back to cited text no. 1
  [Full text]  
2.
Raphael J. 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.   Back to cited text no. 2
    
3.
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. 3
  [Full text]  
4.
Sriniva?salu VK, Pavithran K. 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. 4
    
5.
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. 5
    
6.
Mohile SG, Mohamed MR, Culakova E, Xu H, Loh KP, Magnuson A, et al. A geriatric assessment (GA) intervention to reduce treatment toxicity in older patients with advanced cancer: A University of Rochester Cancer Center NCI community oncology research program cluster randomized clinical trial (CRCT). J Clin Oncol 2020;38:12009a.  Back to cited text no. 6
    
7.
Kiyota N, Tahara M, Fujii H, Yamazaki T, Mitani H, Iwae S, et al. Phase II/III trial of post-operative chemoradiotherapy comparing 3-weekly cisplatin with weekly cisplatin in high-risk patients with squamous cell carcinoma of head and neck (JCOG1008). J Clin Oncol 2020;38:6502.  Back to cited text no. 7
    




 

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