Impact of stereotactic body radiation therapy on geriatric assessment and management for older patients with head and neck cancer using G8.
PURPOSE
Management of head and neck cancers (HNC) in older adults is a common but challenging clinical scenario. We assess the impact of Stereotactic Body Radiation Therapy (SBRT) on survival utilizing the Geriatric-8 (G8) questionnaire.


MATERIALS AND METHODS
171 HNC patients, deemed medically unfit for definitive treatment, were treated with SBRT ± systemic therapy. G8 questionnaires were collected at baseline, at 4-6 weeks, and at 2-3 months post-treatment. Patients were stratified according to their baseline G8 score: <11 as 'vulnerable', 11-14 as 'intermediate', and >14 as 'fit'. Overall survival (OS) was assessed through univariate Kaplan Meier analysis. Repeated measures ANOVA was used to determine if baseline characteristics affected G8 score changes.


RESULTS
Median follow-up was seventeen months. 60% of patients presented with recurrent HNC, 30% with untreated HNC primaries, and 10% with metastatic non-HNC primaries. Median age was 75 years. Median Charlson Comorbidity Index score was 2. 51% of patients were 'vulnerable', 37% were 'intermediate', and 12% were 'fit' at baseline, with median survival of 13.2, 24.3, and 41.0 months, respectively (p = .004). Patients who saw a decrease in their follow-up G8 score (n = 69) had significantly lower survival than patients who had stable or increased follow-up G8 scores (n = 102), with median survival of 8.6 vs 36.0 months (p < .001).


CONCLUSION
The G8 questionnaire may be a useful tool in upfront treatment decision-making to predict prognosis and prevent older patients from receiving inappropriate anti-cancer treatment. Decline in follow-up G8 scores may also predict worse survival and aid in goals of care following treatment.
['Gogineni|Emile|E|', 'Rana|Zaker|Z|', 'Wotman|Michael|M|', 'Karten|Jessie|J|', 'Riegel|Adam|A|', 'Marrero|Mihaela|M|', 'Maduro|Luis|L|', 'Kamdar|Dev|D|', 'Frank|Douglas|D|', 'Paul|Doru|D|', 'Seetharamu|Nagashree|N|', 'Ghaly|Maged|M|']
D000368:Aged D015577:Geriatric Assessment D006258:Head and Neck Neoplasms D006801:Humans D009364:Neoplasm Recurrence, Local D016634:Radiosurgery D011795:Surveys and Questionnaires
Older Cancer G8 SBRT Prognosis Elderly Head neck Quality of life Screening tool