Frailty and Overall Survival of Older Patients Undergoing Radiotherapy for Head and Neck Cancer: A Prospective Analysis
by
, , , , , , and
Chiara Giannotti
1,†, 
Silvia Ottaviani
2,†,
Mariya Muzyka
1,2,
Luca Tagliafico
2,
Almalina Bacigalupo
3,
Liliana Belgioia
3,4,
Celjeta Tominaj
4,
Stefania Vecchio
5,
Fiammetta Monacelli
2,* and
Alessio Nencioni
1,2,* 1
IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
2
Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy
3
Radiation Oncology Department, IRCCS Ospedale Policlinco San Martino, 16132 Genoa, Italy
4
Department of Health Science (DISSAL), University of Genoa, 16132 Genoa, Italy
5
Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
*
Authors to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Cancers 2024, 16(23), 3939; https://doi.org/10.3390/cancers16233939
Submission received: 23 October 2024
/
Revised: 17 November 2024
/
Accepted: 20 November 2024
/
Published: 25 November 2024
(This article belongs to the Special Issue High-Quality Cancer Care in Older Adults)
Simple Summary
Head and neck squamous cell carcinoma (HNSCC) is a common cancer in older adults, but treatment decisions for these patients can be challenging due to age-related factors, such as frailty. This study aimed to evaluate how pre-treatment frailty assessment can help predict survival outcomes and treatment-related side effects in older patients with HNSCC who undergo radiotherapy, with or without chemotherapy. We found that frailty plays a significant role in determining overall survival, but it was not directly related to acute radiation toxicity. Our findings suggest that incorporating frailty assessment into treatment planning could help personalize therapy for older patients, improving decision-making and potentially enhancing long-term outcomes.
Abstract
Background/Objectives: Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its predictive power. We aimed to assess the impact of pre-treatment frailty stratification on overall survival (OS) and acute radiation-related toxicity in a cohort of older patients with HNSCC. Methods: A prospective cohort of 117 patients aged ≥65 years with newly diagnosed HNSCC was enrolled between 2017 and 2022. Patients received RT with or without chemotherapy. Frailty was assessed using the 40-item Frailty Index (FI) as part of a comprehensive geriatric assessment. The primary outcomes were OS and acute RT toxicity, defined as a grade ≥ 3 based on CTCAE 5.0. Cox proportional hazard models and logistic regression models, adjusted for age, tumor stage, and chemotherapy, were used. Results: After a median follow-up of 819 days, FI (HR 1.478, 95% CI 1.182–1.848, p < 0.001) was an independent predictor of OS. Grade ≥ 3 toxicities were observed in 38% of patients, but frailty was not significantly associated with toxicity. A sub-analysis of oropharyngeal carcinoma patients demonstrated improved OS in HPV-positive patients (HR 0.231, 95% CI 0.078–0.686, p = 0.008). Conclusions: the standardized introduction of frailty assessment in the evaluation of older HNSCC patients holds great promise for predicting long-term survival. This approach could be crucial in tailoring treatment protocols that account for the biological heterogeneity of older adults.
