Abstract
In elderly patients treated with concurrent chemoradiation therapy (CCRT), complications after initiation of therapy, such as delirium, as well as adverse events such as radiation mucositis and granulocytopenia, are considered to affect the subsequent therapy completion rate and treatment effect and may also lead to a poor performance status (PS). Various factors should be taken into consideration prior to the therapy, such as complications, estimated residual function, PS, life expectancy, and the family environment, along with sufficient informed consent. This study evaluated 100 subjects, including 30 elderly patients (age, ≧70 years) and 70 non-elderly patients (age, <70 years) who underwent primary therapy (S-1, nedaplatin with CCRT; SN therapy) for head and neck squamous cell carcinoma in our hospital from January 2005 to August 2011. The following variables were clinically compared between the elderly and non-elderly groups: primary site, staging, response to treatment, therapy completion rate, recurrence rate, adverse events, PS, and complications. In the elderly group, 90% of the patients achieved complete response (CR) while the remaining 10% achieved partial response (PR), giving a response rate of 100%. In the non-elderly group, 87.1% and 12.9% of the patient achieved CR and PR, respectively, again giving a response rate of 100%. The therapy completion rate was 73.3% in the elderly and 90.0% in the non-elderly group, with recurrence rates of 6.7% and 15.7%, respectively. With regard to adverse events, in the elderly group, 73.3% of the patients experienced hematological toxicities of grade 3 or higher, and 50.0% experienced non-hematological toxicities of grade 3 or higher. In the non-elderly group, 57.1% experienced hematological toxicities of grade 3 or higher and 42.9% experienced non-hematological toxicities of grade 3 or higher. Major complications occurring after initiation of therapy were reported in 20.0% of the elderly population and in 5.6% of the non-elderly population. Significant differences between the groups were found in the therapy completion rate, incidence of adverse events, and complications after therapy initiation. These results suggest that CCRT is as effective in the elderly as it is in non-elderly patients, but applying the therapy in the elderly requires careful consideration of pre-treatment care, management of complications during therapy, and post-treatment rehabilitation.
