Source: www.dental-tribune.com
Author: Franziska Beir, Dental Tribune International

Head and neck cancer is the sixth most common cancer worldwide and results in approximately 450,000 deaths per year. As a result of demographic change, the proportion of older patients with this type of cancer is continuously increasing, and these patients are under-represented in clinical trials. The question of whether older patients should be treated with chemotherapy or drug therapy—in addition to radiotherapy—can cause controversy, and the association with higher survival rates has remained unclear. A large-scale international study involving University of Leipzig Medical Center and 12 other university hospitals has now proved the effectiveness of this combined treatment.

Cancer treatment for older patients is more individualised compared with that for younger patients, owing to an increasing prevalence of frailty, comorbidities and a higher vulnerability to chemotherapy-related toxic effects. Standardised treatment for head and neck cancer either entails surgical removal of the tumour followed by radiotherapy or organ-preserving radiotherapy in combination with chemotherapy. The latter treatment is especially controversial, and there has been a lack of clinical data to determine the best option.

The study involved 12 university hospitals in Europe and the US. The researchers analysed data from 1,044 older patients (65 years or older) with head and neck cancer of the oral cavity, pharynx or larynx. Between 2005 and 2019, 234 of these patients were treated with radiotherapy alone and 810 with radiotherapy in combination with either chemotherapy (677) or an alternative drug therapy with an antibody against a growth factor receptor (133).

The study findings demonstrated that radiotherapy in combination with chemotherapy was associated with improved survival rates compared with radiotherapy alone. This advantage was particularly prominent in patients aged between 65 and 79 years and in those with good general health and few comorbidities.

“In particular, fit older patients with minor comorbidities should not be denied this effective therapy simply because of their advanced age,” explained study leader Dr Nils Nicolay, professor at the Department of Radiation Oncology at the University of Leipzig, in a press release.

“In contrast, radiotherapy combined with taking the growth factor antibody showed no survival benefit compared to radiotherapy alone,” he added.

International registry in the making
Currently, an international registry for older patients with head and neck cancer is being set up by University of Leipzig Medical Center, and more than 20 centres in Europe, Australia and the US are interested in collaborating.

“In collaboration with other international research groups, additional modelling of the biological parameters will be carried out to better predict which older patients would benefit from combined radiotherapy and chemotherapy,” explained lead author Dr Alexander Rühle, from the Department of Radiation Oncology at the University of Leipzig.

The study, titled “Evaluation of concomitant systemic treatment in older adults with head and neck squamous cell carcinoma undergoing definitive radiotherapy”, was published in the February 2023 issue of Jama Network Open.