Effectiveness of chemoradiation for head and neck cancer in an older patient population

Noam Vanderwalde, Anne Marie Meyer, Allison M. Deal, J. Bradley Layton, Huan Liu, William R. Carpenter, Mark C. Weissler, David N. Hayes, Mary E. Fleming, Bhishamjit S. Chera

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results The final cohort of 10,599 patients was 68% male and 89% white. Median age was 74 years. Seventy-four percent were treated with RT, 26% were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95% confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95% CI: 1.02-1.15; P=.01). Conclusions Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume89
Issue number1
DOIs
StatePublished - May 1 2014
Externally publishedYes

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Head and Neck Neoplasms
therapy
cancer
radiation therapy
Population
hazards
Radiotherapy
death
mortality
Therapeutics
Propensity Score
confidence
Proportional Hazards Models
epidemiology
intervals
Confidence Intervals
logistics
chemotherapy
Weights and Measures
surveillance

All Science Journal Classification (ASJC) codes

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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Effectiveness of chemoradiation for head and neck cancer in an older patient population. / Vanderwalde, Noam; Meyer, Anne Marie; Deal, Allison M.; Layton, J. Bradley; Liu, Huan; Carpenter, William R.; Weissler, Mark C.; Hayes, David N.; Fleming, Mary E.; Chera, Bhishamjit S.

In: International Journal of Radiation Oncology Biology Physics, Vol. 89, No. 1, 01.05.2014, p. 30-37.

Research output: Contribution to journalArticle

Vanderwalde, N, Meyer, AM, Deal, AM, Layton, JB, Liu, H, Carpenter, WR, Weissler, MC, Hayes, DN, Fleming, ME & Chera, BS 2014, 'Effectiveness of chemoradiation for head and neck cancer in an older patient population', International Journal of Radiation Oncology Biology Physics, vol. 89, no. 1, pp. 30-37. https://doi.org/10.1016/j.ijrobp.2014.01.053
Vanderwalde, Noam ; Meyer, Anne Marie ; Deal, Allison M. ; Layton, J. Bradley ; Liu, Huan ; Carpenter, William R. ; Weissler, Mark C. ; Hayes, David N. ; Fleming, Mary E. ; Chera, Bhishamjit S. / Effectiveness of chemoradiation for head and neck cancer in an older patient population. In: International Journal of Radiation Oncology Biology Physics. 2014 ; Vol. 89, No. 1. pp. 30-37.
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abstract = "Purpose The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results The final cohort of 10,599 patients was 68{\%} male and 89{\%} white. Median age was 74 years. Seventy-four percent were treated with RT, 26{\%} were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95{\%} confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95{\%} CI: 1.02-1.15; P=.01). Conclusions Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.",
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AU - Meyer, Anne Marie

AU - Deal, Allison M.

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AU - Liu, Huan

AU - Carpenter, William R.

AU - Weissler, Mark C.

AU - Hayes, David N.

AU - Fleming, Mary E.

AU - Chera, Bhishamjit S.

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N2 - Purpose The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results The final cohort of 10,599 patients was 68% male and 89% white. Median age was 74 years. Seventy-four percent were treated with RT, 26% were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95% confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95% CI: 1.02-1.15; P=.01). Conclusions Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.

AB - Purpose The purpose of this study was to compare chemoradiation therapy (CRT) with radiation therapy (RT) only in an older patient population with head and neck squamous cell carcinoma (HNSCC). Methods and Materials Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (1992-2007), we identified a retrospective cohort of nonmetastatic HNSCC patients and divided them into treatment groups. Comparisons were made between CRT and RT cohorts. Propensity scores for CRT were estimated from covariates associated with receipt of treatment using multivariable logistic regression. Standardized mortality ratio weights (SMRW) were created from the propensity scores and used to balance groups on measured confounders. Multivariable and SMR-weighted Cox proportional hazard models were used to estimate the hazard ratio (HR) of death for receipt of CRT versus RT among the whole group and for separate patient and tumor categories. Results The final cohort of 10,599 patients was 68% male and 89% white. Median age was 74 years. Seventy-four percent were treated with RT, 26% were treated with CRT. Median follow-up points for CRT and RT survivors were 4.6 and 6.3 years, respectively. On multivariable analysis, HR for death with CRT was 1.13 (95% confidence interval [CI]: 1.07-1.20; P<.01). Using the SMRW model, the HR for death with CRT was 1.08 (95% CI: 1.02-1.15; P=.01). Conclusions Although the addition of chemotherapy to radiation has proven efficacious in many randomized controlled trials, it may be less effective in an older patient population treated outside of a controlled trial setting.

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