54 / 154
S24
A B S T R A C T S
addition of chemotherapy to radiotherapy (RT) in patients
older than 70. The importance of age as a surrogate for
comorbidity and other treatment-influencing factors remains
unclear and thus, significant controversy exists in clinical
practice regarding whether elderly patients benefit from the
addition of concurrent chemotherapy to RT.
Objectives:
We sought to engage the National Cancer
Database (NCDB) to determine treatment patterns and
outcomes for patients over 70 years of age with a biopsy-
proven diagnosis of SCC of the oropharynx (base of tongue,
tonsil, or OPC NOS) in whom chemotherapy would typically
be indicated (T3-4 or N+ disease).
Methods:
The NCDB was queried for patients over 70
with a diagnosis of OPC SCC. Treatments were divided
into the following categories: definitive RT and definitive
chemoradiation. Multiple imputation was utilized to account
for missing data. Chi-squared analysis was used to determine
treatment association. Overall survival analyses were
conducted with Kaplan-Meier/log-rank and Cox models.
Results:
We analyzed 7,989 patients with OPC SCC at a
median follow-up of 46.0 months. Median age was 75 years.
Definitive RT was utilized in 19.3% and CRT was utilized in
80.7% of patients (87.5% between ages 70-75 vs 46.6% for age
86+).The use of CRT was positively influenced by: non-African
American race, non-Hispanic background, private insurance,
base of tongue primary, larger tumor size, younger patient
age, increasing nodal burden, higher AJCC clinical stage, male
gender, lower comorbidity index, later year of diagnosis, and
higher grade.
Five-year overall survival for definitive RT was 21.6% and
for CRT was 42.1% (p<0.01). CRT conferred a 40% survival
advantage in multivariate analysis (HR 0.60 [95%CI 0.556-
.647], p<0.01). On multivariate analysis, poorer survival was
noted in patients with increasing comorbidity score, non-
Caucasian race, earlier year of diagnosis, treatment facility
in the Western United States, stage 4A/B disease, non-base
of tongue/tonsillar primaries, larger primaries, distance from
treatment center, and older age (all p<0.01).
Conclusion:
National practice patterns continue to favor
concurrent chemoradiotherapy, even in elderly patients with
advanced OPC SCC. Despite the meta-analysis suggesting
that the survival benefit of concurrent chemotherapy may
be limited to those under 70 years of age, this large national
registry-based analysis challenges the paradigm of omitting
chemotherapy based purely on advanced age.
Disclosure of interest:
None declared
Keywords:
HPV, oropharynx, outcomes, patterns of care
O03
GERIATRIC ASSESSMENT AND OUTCOMES WITH
CARBOPLATIN AND WEEKLY LOW-DOSE PACLITAXEL IN
ELDERLY WOMEN WITH OVARIAN, PRIMARY PERITONEAL
OR FALLOPIAN TUBE CANCER: A GYNECOLOGIC ONCOLOGY
GROUP STUDY (GOG273)
W. Tew
1,
*, H. Huang
2
, V. Von Gruenigen
3
, A. Hurria
4
, T. Herzog
5
,
L. Landrum
6
, R. Salani
7
, S. Lele
8
, M. Pearl
9
, A. Alvarez Secord
10
,
J. Fiorica
11
, T. Rizack
12
, W. E. Richards
13
, G. Fleming
14
1
Dept of Medicine, Gynecologic Medical Oncology Service,
Memorial Sloan Kettering Cancer Center, NY,
2
GOG Statistics and
Data Center, Buffalo, NY,
3
Summa Akron City Hospital, Akron,
OH,
4
City of Hope, Duarte, CA,
5
University of Cincinnati Cancer
Institute, Cincinnati, OH,
6
University of Oklahoma, OK,
7
The
Ohio State University Wexner Medical Center, OH,
8
Roswell Park
Cancer Institute, Buffalo, NY,
9
Stony Brook University Hospital,
Stony Brook, NY,
10
Duke Cancer Center, NC,
11
Indiana University,
Bloomington,
12
Women and Infants Hospital Rhode Island, RI,
13
Candler Hospital, GA,
14
University of Chicago, Chicago, IL, USA
Introduction:
Older women with primary ovarian cancer
are less likely to be offered standard cancer treatments,
develop more toxicity and have lower survival rates.
Objectives:
To better understand this outcome disparity, the
Gynecologic Oncology Group (GOG) conducted a prospective
cohort trial to explore whether the completion of 4 cycles of
weekly low-dose paclitaxel and carboplatin chemotherapy
was associated with a baseline geriatric risk score and
additional patient-reported outcomes (PROs)
Methods:
Eligible women were 70yrs and older regardless
of performance status (PS 0-3) with newly diagnosed,
pathologic-confirmed adenocarcinoma of the ovary, perito-
neum, or fallopian tube. Patients (pts) were planned to
receive carboplatin AUC 5 on day 1, paclitaxel 60mg/m
2
over
one hour weekly on day 1 and 8 (day 15 was optional) for 4
cycles (q21 days), either after primary surgery or as neo-
adjuvant chemotherapy (NACT). Dose reductions at cycle
1 were allowed per physician discretion. The completion of
chemotherapy was defined as completing 4 cycles without
dose reduction and/or more than 7 days treatment delay on
chemotherapy administration on day 1 and day 8. A geriatric
risk score (modified CARG score, Hurria et al, JCO 2011) was
calculated based on pts’s age, functional dependency, social
activity, fall history, hearing and labs (Hb, Cr). The PROs (at
baseline, pre-cycle 3, and post-cycle 4) included function:
instrumental activities of daily living (IADL) and activities of
daily living (ADL), quality of life (FACT-O), neurotoxicity (FACT/
GOG-Ntx short scale) and social support measures.
Results:
104 evaluable pts were enrolled. Mean age was
78yrs (range: 70-92). Pts were mostly fit (PS 0/1/2/3 = 32%,
53%, 14%, 1%) with advanced stages (stage I-II = 19%; stage
III-IV = 81%) who underwent primary surgery (73%) or NACT
(27%). 16% pts started at reduced doses of carboplatin (AUC
4) or paclitaxel (<60mg/m
2
) at cycle 1 per physician choice.
About two thirds of pts (66%) completed all 4 cycles without
any dose modification/delay. Adverse events attributed to
dose modification were hematologic (n=10), gastrointestinal
(n=3), neurotoxicity (n=2) and other toxicities (n=13). The
geriatric risk score (mean GRS=6) was not associated with