3649 - Impact of Age and Frailty on Outcomes among Patients Undergoing Curative-Intent Treatment for Head and Neck Squamous Cell Carcinomas (HNSCC)
Presenter(s)
E. Vonderhaar Meister1, K. Boudadi2, A. Pabani2, T. Laufer1, C. Gui1, B. R. Page1,3, W. Mydlarz4, L. J. Mady4, C. G. Gourin4, H. Quon1, and C. Kut1,3; 1Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, 2Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 3Johns Hopkins University Department of Radiation Oncology, Washington, DC, 4Department of Otolaryngology Johns Hopkins University School of Medicine, Baltimore, MD
Purpose/Objective(s): Concurrent chemoradiation (cCRT) is standard for many patients with HNSCC, but responses in elderly and/or frail patients are heterogenous. The benefit of chemotherapy added to radiation declines with age, yet management of geriatric HNSCC patients remains controversial as providers balance the goal for cure with treatment tolerability. Indeed, optimal patient selection among elderly for cCRT is unclear. Assessing impacts of frailty on outcomes is challenging as standardized frailty tools are not routinely implemented or validated in this population. This study examined the implications of age and frailty on oncologic and treatment-related outcomes.
Materials/Methods: A retrospective study was conducted of patients with nonmetastatic HNSCC (oral cavity, oropharynx, larynx and nasopharynx) treated with curative-intent radiotherapy (RT) or cCRT from 2015-19 at our institution. Data were obtained via chart review. Comorbidities were quantified by Charlson Comorbidity Index (CCI). Frailty scores were calculated via Risk Analysis Index (RAI-A). Statistical analyses appropriate to size and distribution were performed using Rv4.5.1.
Results: Of 360 patients analyzed, 59 (16%) were aged =70. In patients aged <70, median CCI was 2 (90% 10-year predicted survival), compared with 4 (53% 10-year predicted survival) in patients aged =70. Overall and progression-free survival were significantly higher for patients <70 (p = 0.007 and p = < 0.001), with 5-year OS 81% (age <70) vs 67% (age =70). Elderly patients =70 were more likely to receive RT alone (16.9% vs 8.6%, p = 0.008). Of patients =70 treated with cCRT (n = 49) or RT alone (n = 10), within 3 months of treatment hospitalization occurred in 49% vs 30%, ED visit in 14% vs 0%, and NG tube placement in 27% vs 10%, respectively. Median weight loss was greater in the cCRT group (5.2 vs 2.0 kg). RAI-A frailty scores of patients =70 classified 28.8% as normal, 55.9% as frail, and 15.3% as very frail. Increasing RAI score was associated with worse mortality (HR 1.09, 95% CI 1.03–1.26; p = 0.002), increased hospitalizations (OR 1.08, 95% CI 0.99-1.19, p = 0.08), lower lymphocyte counts at baseline (r = -0.22, p = 0.1) and by maximum decline (r = -0.29, p = 0.03).
Conclusion: Frailty characterization has the potential to identify elderly patients most likely to benefit from curative-intent paradigm in HNSCC. In our cohort, patients =70 had poorer survival and higher comorbidity burden than younger patients. The addition of chemotherapy increased toxicity rates, though statistical analysis is limited by small sample size of this sub-population. Most elderly patients were frail; higher RAI scores correlated with worse survival, greater care needs, and lower blood counts, suggesting hematologic markers may serve as indicators of physiologic reserve. These data support the use of routine pre-treatment frailty assessments and warrant inclusion of frailty metrics in future trials to guide clinical decision-making.