Abstract | OBJECTIVES/HYPOTHESIS: STUDY DESIGN: Retrospective database study. METHODS: Using the National Cancer Database, we identified 1,686 elderly patients (age ≥70 years) with resected HNSCC with SM+ and/or ECE, who received adjuvant CRT (491 patients, 29%) or adjuvant RT alone (1,195 patients, 71%) between 1998 and 2011. Three-year survival rates were estimated using the Kaplan-Meier method both before and after propensity score matching (PSM). Crude and adjusted hazard ratios (HR) with 95% confidence intervals (CI) were computed using Cox regression modeling. RESULTS: Median follow-up was 23.5 and 42.8 months for all and surviving patients, respectively. Three-year OS was 50.7% and 44.4% among patients receiving adjuvant CRT and RT alone, respectively (P = .002). On multivariate analysis, there was no significant improvement in OS with adjuvant CRT relative to adjuvant RT alone (HR: 0.88, 95% CI: 0.73-1.06). Similarly, a PSM cohort showed no significant difference in the 3-year OS for patients receiving adjuvant CRT versus adjuvant RT alone (48.8% and 50.9%, respectively; P = .839). CONCLUSIONS: Although the addition of chemotherapy to adjuvant RT has been proven effective in randomized trials of patients with resected HNSCC with SM+ or ECE, it may be less efficacious in an elderly patient population treated outside of a controlled trial setting. LEVEL OF EVIDENCE:
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Authors | Nicholas J Giacalone, Muhammad M Qureshi, Kimberley S Mak, Diana Kirke, Sagar A Patel, Bhartesh A Shah, Andrew R Salama, Scharukh Jalisi, Minh Tam Truong |
Journal | The Laryngoscope
(Laryngoscope)
Vol. 128
Issue 4
Pg. 831-840
(04 2018)
ISSN: 1531-4995 [Electronic] United States |
PMID | 28833217
(Publication Type: Evaluation Study, Journal Article)
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Copyright | © 2017 The American Laryngological, Rhinological and Otological Society, Inc. |
Topics |
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell
(mortality, pathology, therapy)
- Chemoradiotherapy, Adjuvant
(mortality)
- Female
- Humans
- Laryngeal Neoplasms
(mortality, pathology, therapy)
- Laryngectomy
(methods, mortality)
- Male
- Margins of Excision
- Middle Aged
- Propensity Score
- Proportional Hazards Models
- Retrospective Studies
- Salvage Therapy
(methods, mortality)
- Survival Rate
- Treatment Outcome
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