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Session Item

Saturday
August 28
08:00 - 08:40
N103
The role of RTT leadership in advancing multi-disciplinary research
Sophie Perryck, Switzerland
0070
Teaching lecture
RTT
09:25 - 09:33
Age related toxicity and outcome in oropharyngeal and nasoparyngeal cancer patients
PH-0043

Abstract

Age related toxicity and outcome in oropharyngeal and nasoparyngeal cancer patients
Authors: IVALDI|, Eliana(1)*[ivaldieliana@yahoo.it];Infante|, Gabriele(2);Facchinetti|, Nadia(1);Bossi|, Paolo(3);Iacovelli|, Nicola Alessandro(1);Cavallo|, Anna(4);Ingargiola|, Rossana(1);Locati|, Laura Deborah(5);Bergamini|, Cristiana(5);Resteghini|, Carlo(5);Licitra|, Lisa (5);Platini|, Francesca(5);Calareso|, Giuseppina(6);Fallai|, Carlo(1);Orlandi|, Ester(7);
(1)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Radiotherapy 2 Department, Milan, Italy;(2)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Unit of Clinical Epidemiology and Trial Organization, Milan, Italy;(3)ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy;(4)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Unit of Medical Physics, Milan, Italy;(5)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Head and Neck Medical Oncology Department, Milan, Italy;(6)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Department of Radiology, Milan, Italy;(7)Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Radiotherapy 1-2 Department, Milan, Italy;
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Purpose or Objective

To evaluate toxicity and outcome in elderly oropharyngeal (OPC) and nasopharyngeal cancer (NPC) patients (pts) treated with intensity modulated radiation therapy (IMRT) with/without chemotherapy (CHT).

Material and Methods

We retrospectively analyzed a total number of 392 pts (213 OPC and 179 NPC) that underwent IMRT with/without concurrent CHT and/or induction CHT from 2006 to 2017. All patients were categorized in ≥65 years old (elderly) and <65 (younger).Overall survival (OS) and disease free survival (DFS) were estimated with Kaplan-Meier curves and compared with the log-rank test. Acute toxicity rate (> G3) according to CTCAE v4.0 was also analyzed. Baseline Epstein Barr Virus plasma Load was collected in 90% of NPC pts and human papilloma virus (HPV) status was recorded in 95% of OPC pts. We reported toxicity and outcome results for the following categories: NPC population, OPC pts and HPV positive and negative cohorts.

Results

OS stratified for age showed a better outcome for younger pts in OPC (HR 2.06, CI 1.14 - 3.72) and NPC population (HR 4.3, CI 1.83 - 10.09). Also in OPC HPV positive pts (HR 2.97, CI 1.2 - 7.31), mortality is greater in older pts compared to younger ones. No statistical significance in OS was found in OPC HPV negative group between younger and older pts (fig.1). Age at diagnosis seems to be statistically significantly related to the OS in all categories except in OPC HPV negative.

DFS stratified for age showed a better outcome for younger pts in NPC (HR 2.85, CI 1.51 - 5.38) and OPC HPV positive population (HR 2.4, CI 1.06 - 5.44). In all groups, younger pts showed a better DFS than older, however only for NPC and OPC HPV positive pts is statistically significant (fig.2). Like the OS, age at diagnosis seems to be related to DFS in the entire cohort except for the OPC HPV negative group.

Analyses performed to identify correlation between toxicities and other variables stratified for age showed that BMI (cut off 25 Kg/m2) is generally associated with toxicity only in the OPC patients, but independently of the age. In OPC population and in OPC HPV positive sub-group, gender seems to have an interaction with age even if not statistically significant. Indeed, younger men appear to have a major risk of toxicity than younger women. On the contrary, older women are more at risk than men. Old NPC pts with N2-N3 category (according to AJCC 7 edition) are more likely to develop a G3 toxicity than N0-1 pts (OR 4.48, CI 0.99 - 20.35). Age was statistically significantly related to dermatitis in both NPC (OR 2.64, CI 1.06-6.54) and OPC populations (OR 6.23, CI 1.88 - 20.67).
Conclusion

In conclusion, older NPC, OPC and OPC HPV positive pts showed a markedly worse survival than the younger counterparts. HPV status was confirmed to be a positive prognostic factor independently of age. Age was statistically significantly related to dermatitis in all population.