1235 - Hypo-Slow Radiotherapy Combined with Capecitabine in Very Elderly Patients (=78 Years) with Locally Advanced Head and Neck Cancer: A Prospective Exploratory Study

09:20am - 09:25am ET

Room 156

Presenter(s)

Shichuan Zhang, MD, PhD - Sichuan Cancer Hospital and Institute, ???, ???

Y. Zhao¹, C. Mou², W. Liao¹, and S. Zhang³; ¹Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center; Cancer Hospital affiliate to University of Electronic Science and Technology of China, Chengdu, Sichuan, China, ²Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, chengdu, China, ³Department of Radiation Oncology, Sichuan Cancer Hospital& Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China

Purpose/Objective(s):

The optimal treatment for very elderly patients (=78 years) with locally advanced head and neck cancer (HNC) remains poorly defined, as these patients are often underrepresented in clinical trials and poorly tolerate standard multimodal regimens. Conventional fractionated radiotherapy with concurrent chemotherapy confers diminishing survival benefits with advancing age while imposing substantial toxicity and treatment burden. Hypofractionated regimens offer reduced treatment frequency and may improve tolerability, but prospective data in this population remain limited. This study aimed to evaluate the safety, efficacy, and feasibility of Hypo-Slow Radiotherapy (HSRT) combined with capecitabine in patients aged =78 years with locally advanced HNC.

Materials/Methods:

In this single-arm, prospective exploratory study, patients aged =78 years with histologically confirmed locally advanced squamous cell HNC (stage III–IVB, AJCC 8th edition) and ECOG performance status 0–2 received HSRT (4 Gy per fraction, once weekly, to a maximum of 60 Gy) combined with oral capecitabine (600 mg twice daily on days 1–3 of each treatment week). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), treatment adherence, and safety (CTCAE v5.0). Outcomes were compared with a historical control cohort comprising patients treated with conventional CRT or surgery.

Results: A total of 20 patients were enrolled (median age 85 years; range 79–92). The ORR was 70.59% (12/17 evaluable patients), and the DCR was 100%. With a median follow-up of 33 months, median overall survival (OS) 29 months (95% CI, 25.0–41.0 months), and the median progression-free survival (PFS) was 25 months (95% CI, 16.0–30.0 months). The 1-, 2-, and 3-year OS rates were 80.0%, 60.0%, and 37.8%, respectively. No grade =4 adverse events were observed, and grade 3 toxicities were infrequent. Compared with historical controls, HSRT plus capecitabine achieved significantly better OS than conventional CRT (median 29 vs. 16 months; HR = 0.48, 95% CI: 0.25–0.93; P = 0.028, log-rank test) and comparable to surgery. The once-weekly schedule reduced hospital visits by approximately 50% compared with conventional regimens.

Conclusion: HSRT combined with capecitabine is a safe, well-tolerated, and effective treatment for very elderly patients with locally advanced HNC. The regimen offers a favorable balance between efficacy and toxicity while substantially reducing treatment burden and healthcare resource utilization. These findings are particularly relevant for resource-limited settings and public health emergencies, where treatment simplification is paramount. This study provides a foundational rationale for future large-scale prospective trials in this underrepresented population.