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Mario Airoldi, MD; Giorgio Cortesina, PhD; Carlo Giordano, PhD; Fulvia Pedani, MD; Anna Maria Gabriele, MD; Sara Marchionatti, MD; Cesare Bumma, MD

Arch Otolaryngol Head Neck Surg. 2004;130:161-166.

Background  In head and neck cancer, the locoregional failure of patients with positive margins, vascular or perineural invasion, and extracapsular spread is high and results in poor survival.

Objective  To assess the effect of adjuvant chemoradiotherapy in improving treatment outcomes among older patients with head and neck cancer.

Methods  Forty patients undergoing radical surgery (median age, 73.5 years [range, 70-78 years]) were enrolled (35 men and 5 women; Eastern Cooperative Oncology Group performance status, grade 0-2). Disease sites included the oral cavity (10 patients), oropharynx (12 patients), hypopharynx (8 patients), and larynx (10 patients); pathological TNM classifications included T1 N2 (8 patients), T2 N1-2 (12 patients), T3 N0-2 (8 patients), and T4 N0-2 (12 patients), with the following poor prognostic factors: positive margins (6 patients), vascular invasion (14 patients), neural invasion (16 patients), and extracapsular spread (26 patients). All patients were treated with carboplatin (30 mg/m² on days 1-5 of weeks 1, 3, and 5) concomitant with radiotherapy (54.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes; 5 daily fractions of 1.8 Gy each per week).

Results  No grade 4 toxicity was observed. Grade 3 toxicity included mucositis (10 patients), neutropenia (6 patients), dermatitis (2 patients), and thrombocytopenia (1 patient). The radiotherapy dose administered was 52.0 Gy to all risk volumes plus 10.0 Gy to high-risk volumes. Thirty-two patients (80%) received 3 cycles, 6 (15%) received 2 cycles, and 2 (5%) received 1 cycle. Three-year survival was as follows: disease-free survival, 58%; overall survival, 64%; and local control, 79%.

Conclusions  Adjuvant chemoradiotherapy may be successful in fit older patients. The results of adjuvant chemoradiotherapy were better than those observed in a comparable group treated with radiotherapy alone and were similar to those observed in a younger group with the same poor prognostic factors treated with adjuvant carboplatin plus radiotherapy.

From the Departments of Medical Oncology (Drs Airoldi, Pedani, Marchionatti, and Bumma) and Radiotherapy (Dr Gabriele), San Giovanni Antica Sede Hospital, and the Otorhinolaryngology Department, Turin University and Molinette Hospital (Drs Cortesina and Giordano), Torino, Italy. The authors have no financial interest in this article.

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