PURPOSE Elderly patients with locally advanced head and neck squamous cell carcinoma (HNSCC) often present with frailty and multiple comorbidities, which reduce their tolerance to standard oncologic treatments. This study evaluates the outcomes of hypofractionated radiotherapy (RT) in frail elderly patients with HNSCC after geriatric assessment. METHODS A prospective study was conducted among 154 elderly patients with nonmetastatic HNSCC (60 years and older) between October 2023 and October 2024. The G8 geriatric screening tool identified frail patients (G8 ≤ 14), who subsequently underwent a comprehensive geriatric assessment (CGA). Patients deemed unfit for radical treatment received hypofractionated RT. Treatment outcomes, toxicity, and survival were analyzed. RESULTS Of 154 patients, 90 (58.45%) had G8 scores ≤14, indicating the need for CGA. Among them, 53 (58.88%) were unfit for definitive therapy and received hypofractionated RT. With a median follow-up of 3 months, the median overall survival (OS) was 6.5 months. At 3 months post-treatment, 39.6% of patients were alive, whereas 60.4% had died. There is a strong relation between G8 score and survival (regression coefficient B = 1.969, adjusted R 2 = 0.574, P 11 (3.66 v 11.10 months; P < .001). Among all domains of CGA, patients with normal nutritional status and low comorbidity index had significantly better OS (for Mini Nutritional Assessment, P < .001; for Charlson comorbidity index, P = .004). Treatment was well-tolerated, with minimal grade 3 toxicity. CONCLUSION Hypofractionated RT is a feasible option for frail elderly patients with HNSCC, improving symptom control with manageable toxicity. G8 and CGA assessments facilitate personalized treatment, emphasizing quality of life over curative intent.
Soni et al. (Fri,) studied this question.