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Cancers
Special Issues
Chemoradiotherapy for Head-and-Neck Cancer in the Elderly
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Chemoradiotherapy for Head-and-Neck Cancer in the Elderly

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 6907

Special Issue Editor

Prof. Nils Nicolay

E-Mail Website
Guest Editor
Department of Radiation Oncology, Freiburg University Medical Center, 79106 Freiburg, Germany
Interests: radiation oncology; head-and-neck cancer; functional PET hypoxia imaging; particle therapy; radiobiology; mesenchymal stem cells; tissue-based biomarkers; mobile applications in radiotherapy treatment

Special Issue Information

To date, about a quarter of all head-and-neck cancer (HNC) patients are aged above 65 years, and considering the demographic changes, the prevalence of elderly HNC patients will further increase in the foreseeable future. Therapeutic management for elderly HNC patients is challenging due to the increased rate of comorbidities and poorer performance status. As elderly patients were either excluded or considerably underrepresented in the landmark trials defining the treatment for HNC, the optimal therapeutic approach for this often vulnerable patient cohort remains a matter of debate. Surgical approaches are often limited by comorbidities or performance status in elderly HNC patients and may also require adjuvant (chemo)radiation in case of clinical or pathological risk factors. Definitive (chemo)radiation defines a treatment standard for HNC patients, and especially elderly and vulnerable patients may benefit from non-surgical approaches due to an increased risk for perioperative morbidity and mortality. However, treatment algorithms for definitive (chemo)radiation may also require adjustments for age, as elderly HNC patients have been found to benefit less from concomitant chemotherapy or altered fractionation regimens during definitive radiotherapy. Since it is well established that biological age rather than chronological age determines compliance, treatment tolerability, and outcomes, therapeutic decision-making for elderly HNC patients is further complicated. The utilization of standardized assessments for comorbidities, geriatric performance, and patient-reported outcomes is still largely lacking in clinical practice; however, these tools may help significantly to guide physicians in their treatment decisions.
This Special Issue will publish original research articles, reviews, and commentaries that focus on treatment decisions and potential predictors for outcomes of elderly head-and-neck cancer patients undergoing (chemo)radiation.

Prof. Nils Nicolay
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • head-and-neck cancer
  • radiotherapy
  • chemotherapy
  • elderly patients
  • geriatric patients

Published Papers (3 papers)

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Research

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14 pages, 2037 KiB  
Article
Surviving Elderly Patients with Head-and-Neck Squamous Cell Carcinoma—What Is the Long-Term Quality of Life after Curative Radiotherapy?
by Alexander Rühle, Erik Haehl, Tobias Kalckreuth, Raluca Stoian, Simon K. B. Spohn, Tanja Sprave, Constantinos Zamboglou, Eleni Gkika, Andreas Knopf, Anca-Ligia Grosu and Nils H. Nicolay
Cancers 2021, 13(6), 1275; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers13061275 - 13 Mar 2021
Cited by 9 | Viewed by 1979
Abstract
The effects of radiotherapy on the long-term quality of life (QoL) of surviving elderly HNSCC patients are not well understood, therefore, we analyzed QoL in this population. A cross-sectional analysis was performed at a tertiary cancer center to assess long-term QoL in elderly [...] Read more.
The effects of radiotherapy on the long-term quality of life (QoL) of surviving elderly HNSCC patients are not well understood, therefore, we analyzed QoL in this population. A cross-sectional analysis was performed at a tertiary cancer center to assess long-term QoL in elderly HNSCC patients. Eligible patients were ≥65 years at the time of treatment who had to be alive for ≥1 year after radiotherapy and without current anti-cancer treatment. QoL and patient satisfaction were assessed using the EORTC QLQ-C30, QLQ-H&N35 and ZUF-8 questionnaires, respectively, and treatment-related toxicities were graded according to CTCAE (Common Terminology Criteria of Adverse Effects) v.5.0. Seventy-four patients met the inclusion criteria, of which 50 consented to participate. Median time between radiotherapy and QoL assessment was 32 months (range 12–113). The QLQ-C30 global QoL median amounted to 66.7 points (interquartile range (IQR) 50.0–83.3), which was comparable to the age- and gender-adjusted German population (median 65.3). Median global QoL was similar between patients undergoing definitive (75.0, IQR 50.0–83.3) and adjuvant (chemo)radiotherapy (66.7, IQR 41.7–83.3, p = 0.219). HPV-positive HNSCC patients had superior global QoL after radiotherapy than their HPV-negative counterparts (p < 0.05), and concomitant chemotherapy did not influence the long-term QoL (p = 0.966). Median global QoL did not correspond with physician-assessed highest-graded chronic toxicities (p = 0.640). The ZUF-8 ranged at 29 points in median (IQR 27–31), showing high patient satisfaction. Surviving elderly HNSCC patients treated by radiotherapy exhibit a relatively high long-term global QoL which is a relevant information for clinicians treating elderly HNSCC patients. Full article
(This article belongs to the Special Issue Chemoradiotherapy for Head-and-Neck Cancer in the Elderly)
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Review

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16 pages, 347 KiB  
Review
Nonsurgical Treatment Strategies for Elderly Head and Neck Cancer Patients: An Emerging Subject Worldwide
by Hiroshi Okuda, Hirofumi Shibata, Takahiro Watanabe, Kosuke Terazawa, Kenichi Mori, Natsuko Ueda, Toshimitsu Ohashi and Takenori Ogawa
Cancers 2022, 14(22), 5689; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14225689 - 19 Nov 2022
Viewed by 1779
Abstract
Consistent with the increasing rate of head and neck cancers among elderly adults, there has been an increase in the rate of those receiving nonsurgical treatments to maintain their function and quality of life. However, various problems, such as poor tolerance to chemoradiotherapy-related [...] Read more.
Consistent with the increasing rate of head and neck cancers among elderly adults, there has been an increase in the rate of those receiving nonsurgical treatments to maintain their function and quality of life. However, various problems, such as poor tolerance to chemoradiotherapy-related toxicity, are of greater concern in elderly adults than in younger individuals. In this review, we describe adverse events that should be particularly noted in elderly patients and provide an overview of countermeasures in nonsurgical treatments. We mainly focus on cisplatin-based chemoradiotherapy—the primary treatment for head and neck squamous cell carcinoma (HNSCC). Furthermore, we review the molecular targeted drugs and immune checkpoint inhibitors for elderly patients with HNSCC. Although the number of older patients is increasing worldwide, clinical trials aimed at determining the standard of care typically enroll younger or well-conditioned elderly patients. There is still very little evidence for treating elderly HNSCC older patients, and the question of optimal treatment needs to be explored. Full article
(This article belongs to the Special Issue Chemoradiotherapy for Head-and-Neck Cancer in the Elderly)
16 pages, 613 KiB  
Review
Management of Older Adults with Locally Advanced Head and Neck Cancer
by Daniel R. Dickstein, Eric J. Lehrer, Kristin Hsieh, Alexandra Hotca, Brianna M. Jones, Ann Powers, Sonam Sharma, Jerry Liu, Vishal Gupta, Loren Mell, Zain Husain, Diana Kirke, Krzysztof Misiukiewicz, Marshall Posner, Eric Genden and Richard L. Bakst
Cancers 2022, 14(11), 2809; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14112809 - 05 Jun 2022
Cited by 8 | Viewed by 2464
Abstract
Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity [...] Read more.
Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity on optimal management. Older adults are a complex patient population, often requiring increased support due to issues relating to functional and performance status, medical comorbidities, and medication management. Furthermore, in older adults with HNSCC, many of these conditions are independently associated with increased toxicity and worse outcomes. Toxicity in the older adult remains difficult to predict and to understand, and as treatment decisions are based on treatment tolerability, it is essential to understand the toxicities and how to minimize them. Novel predictive scores are being developed specifically for older adults with HNSCC to understand toxicity and to assist in personalized treatment decisions. There are clinical trials presently underway that are investigating shortened radiation courses and novel, less toxic systemic treatments in this population. In the forthcoming sections, we provide a detailed overview of the clinical data, treatment paradigms, and considerations in this population. This review provides a comprehensive overview of existing clinical data and clinical considerations in the older adult head and neck cancer population. Additionally, we provide a detailed overview of pertinent current and ongoing clinical trials, as well as future areas for investigation. Full article
(This article belongs to the Special Issue Chemoradiotherapy for Head-and-Neck Cancer in the Elderly)
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