A. Ufondu1, D. S. Buchberger2, K. Brito1, S. Alfaifi3, C. Billena4, A. Vidimos5, J. A. Miller2, N. M. Woody2, S. A. Koyfman2, and S. R. Campbell2; 1Cleveland Clinic Foundation, Cleveland, OH, 2Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, 3Cleveland Clinic, Cleveland, OH, 4Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, 5Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH
Purpose/Objective(s): Adjuvant radiotherapy (RT) is standard of care for high risk resected non-melanoma skin cancer of the head and neck, with definitive RT used for unresectable patients. Concerns regarding toxicity in octogenarians can preclude RT use in this population. We report on outcomes and toxicity for octogenarians treated with adjuvant or definitive RT at our institution. Materials/
Methods: For the interval 2003-2023, we surveyed our IRB-approved prospective registry for patients over the age of 80 years with non-melanoma skin cancer of the head and neck treated with adjuvant or definitive RT. Statistical analysis was performed for outcomes including acute toxicity, locoregional failure, and overall survival. CTCAE v5 was used to grade toxicity. Categorical variables were compared utilizing Fisher’s Exact Test. Locoregional failure was estimated using the Cumulative Incidence Function with death as a competing risk. Overall survival was performed using the Kaplan-Meier Method. Results: For the 20-year interval, 68 patients (71 lesions) were included. Median follow-up was 19.9 months. Median age at RT was 83.9 years (range: 80.2-96.2). 20.5% was female. 16.2% was immunosuppressed. Median KPS was 80. 95.8% of tumors were SCC in histology. Of the SCCs, 45.6% were BWH T2b. 95.8% of lesions were treated in the adjuvant setting. All patients completed their prescribed course of RT. Most common sites treated included: the face, pre-auricular area, post-auricular area, and scalp. 64.7% of patients had neck radiotherapy in addition to primary site. Median total dose was 55 Gy (range: 30-66 Gy) in 20 fractions (range: 5-33). Median neck dose was 50.5 Gy (range: 30-66). 94.3% of patients experienced any acute toxicity during RT. 79.4% of patients experienced acute grade 1-2 toxicity, and 13.2% experienced acute grade 3 toxicity. Only 1 patient experienced grade 4 toxicity (dysphagia) and there were no grade 5 toxicities. 20% of patients who received neck RT developed grade 3 or more toxicity versus 15% with no neck RT (p = 0.085). Cumulative incidence of locoregional failure at 12 and 24 months was 10% and 15%, respectively. Overall survival at 12 and 24 months was 65.5% and 44.8%, respectively. 6 patient deaths were directly attributable to cancer progression. Conclusion: Adjuvant and definitive RT for non-melanoma skin cancer of the head and neck in octogenarians is safe and effective. Rates of locoregional failure and severe toxicity are generally low, with no significant difference in patients receiving neck RT versus without.
