Management of unilateral neck irradiation in elderly patients with head and neck cancer: Which place for hypofractionation? A single-centre experience of 43 patients.

Purpose of the study: The purpose of the study was to evaluate retrospectively the acute toxicity and efficacy in terms of locoregional control of a cervical lymph node irradiation using a hypofractionated regimen in frail elderly patients.

Material and methods: Patients receiving unilateral hypofractionated cervical lymph node irradiation at the Institut de cancérologie de Lorraine (France) were retrospectively included. The treatment regimen consisted of delivering 54Gy in 18 fractions to the high-risk tumour or lymph node volume and 45Gy to the prophylactic volume using the technique of simultaneous integrated-boost without concomitant systemic treatment. Toxicity data according to the Common Terminology Criteria for Adverse Events version 4 and survival data were collected.

Results: Forty-three patients were treated between January 2013 and July 2021. The median age was 83 years (range: 78-86.5 years), 32 patients (74.4 %) were male and 25.6 % had WHO status ≥ 2. Histological types were cutaneous squamous cell carcinoma (39 patients), salivary gland carcinoma (three patients) and Merkel cell carcinoma (one patient). The mean duration of treatment was 27 days. Seventeen patients (39.5 %) received radiotherapy alone. Acute toxicity events of grade ≥ 2 at the end of radiotherapy in the 43 patients were described as follows: 58.1 % radiodermatitis (25 patients), 24.6 % mucositis (11 patients), and 18.1 % xerostomia (eight patients). Seven patients (16.3 %) experienced grade ≥ 2 odynodysphagia, with four patients (9.3 %) requiring enteral nutrition. No grade 3 toxicity events were reported at 3 months, 6 months or 1 year. After a median follow-up of 9.2 months (range: 6-18.5 months), 11 patients (25.6 %) of those treated by exclusive irradiation had a complete locoregional response as assessed by CT-scan 3 months. At 6 months, two of 20 patients retained grade 2 xerostomia and only four of 20 patients reported residual grade 1 pain.

Conclusion: Moderately hypofractionated unilateral cervical lymph node radiotherapy appears to be well tolerated in frail elderly patients with an acceptable locoregional control rate, potentially providing an alternative to palliative strategies.