Feasibility and therapeutic safety of ENT-led implementation of curative drug tumor therapy (DTT) in multimorbid head and neck cancer patients (HNC)

 

Introduction Curative DTT represents an ENT medical challenge. In addition to close cooperation with the radiation therapists, the management of side effects must be so effective that, on the one hand, few interruptions to radiation are necessary and, on the other hand, the desired cumulative dose of cisplatin is achieved. Particularly in multimorbid patients, the question arises to what extent DTT can be guaranteed by sole ENT care.

Methods Treatment courses were retrospectively analyzed under the aspects of interruption of therapy, leukopenia requiring isolation and acute renal dysfunction. Risk factors such as tumor stage, comorbidity, frailty and polypharmacy were also taken into account, for which the Charlson Comorbidity Index, the Modified Frailty Index and the Comorbitidty Polypharmacy Score were used.

Results In the local ENT department, a total of 202 cycles of MT for KHT were carried out in 2022, 47% as chemoradiation. Of these patients, 75% had an increased comorbidity and frailty index. The target cisplatin dose was achieved in 80% of patients. Relevant interruptions of radiation only occurred in 1 case, due to treatment-refractory leukopenia. However, one in four patients had to be isolated because of leukopenia, and 41% required G-CSF administration. Furthermore, acute kidney injury occurred in 68% of patients, but this never led to the need for dialysis.

Conclusions The implementation of MT represents an important part of ENT medical expertise, especially in respect of the increasing diversification of therapy regimes. Despite the frequent occurrence of relevant side effects, MT can be safely performed by an ENT department even in multimorbid patients.

Publication History

Article published online:
19 April 2024

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