Older patients with locally advanced head and neck cancers should not be excluded from aggressive treatment, but aggressive treatment should perhaps be used more cautiously and judiciously.

According to research presented at the 2015 American Society of Clinical Oncology Annual Meeting, patients 70 and older have been under-represented in RTOG trials evaluating therapies for locally advanced head and neck cancers relative to their population overall.

In addition, the researchers looked at three large cohorts of patients with head and neck cancers and they found patients older than 70 had poorer survival rates compared to patients younger than 70.

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The study suggested that the problem may be even more pronounced in patients who receive combined modality treatments that included heightened nephrotoxicity, myelosuppression, and ototoxicity.

“We need elder specific trials and we need formal geriatric assessments of patients,” said lead study investigator Julie Ann Kish, MD, of the Moffitt Cancer Center in Tampa, FL.  “There are questions surrounding elder patients tolerability to treatments.”

Dr. Kish and her colleagues analyzed the effect of age on outcome in prospective, phase 3 NRG Oncology/RTOG trials of radiotherapy (XRT) with or without chemotherapy in locally advanced head and neck cancer.

The researchers conducted the analysis because the effect of advanced age on outcome for single agent XRT and combined modality therapy in patients with locally advanced head and neck cancers has not been well defined.

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The effect of age on survival and toxicity was examined in patients on RTOG 9003 testing 3 altered fractionation (fx) XRT schedules compared to standard daily XRT (SFX).

The investigators also looked at patients on RTOG 0129, which compared concurrent SFX + cisplatin (DDP) to accelerated fx with concomitant boost XRT (AFX-C) with DDP.

A third cohort used in this analysis included patients on RTOG 0522. This trial tested AFX-C with concurrent DDP with or without cetuximab.