ACE-27 as a prognostic tool of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy: a real-world, prospective, observational study

Purpose To evaluate the association between comorbidities as assessed by the “Adult Comorbidity Evaluation 27” (ACE-27) and the development of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy. Methods Prospective, single-center cohort of patients with head...

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Bibliographic Details
Published in:Supportive care in cancer 2021-04, Vol.29 (4), p.1863-1871
Main Authors: Monteiro, Ana Raquel, Garcia, Ana Rita, Pereira, Tatiana Cunha, Macedo, Filipa, Soares, Rita Félix, Pereira, Kayla, Serra, Tânia, Khouri, Leila, Ribeiro, João, Teixeira, Maria Margarida
Format: Article
Language:English
Subjects:
Antineoplastic Agents - adverse effects
Cancer
Cancer patients
Care and treatment
Chemoradiotherapy - adverse effects
Chemotherapy
Cohort Studies
Comorbidity
Cytotoxicity
Female
Head & neck cancer
Head and neck cancer
Head and Neck Neoplasms - complications
Humans
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Nursing
Nursing Research
Observational studies
Oncology
Oncology, Experimental
Original Article
Pain Medicine
Prognosis
Prospective Studies
Radiation therapy
Radiotherapy
Rehabilitation Medicine
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Summary:Purpose To evaluate the association between comorbidities as assessed by the “Adult Comorbidity Evaluation 27” (ACE-27) and the development of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy. Methods Prospective, single-center cohort of patients with head and neck cancer treated with chemoradiotherapy (cisplatin 100 mg/m 2 on days 1, 22, and 43; intensity-modulated radiotherapy 60 to 69.96 gray, in 30 to 33 fractions,) between June 2018 and December 2019. ACE-27 was assessed before the start of treatment. Patients were divided in two groups based on ACE-27 grading (none to mild versus moderate to severe comorbidities). Differences in incidence of severe acute toxicity and change in treatment plan between groups were examined. Results A total of 101 patients were included: 90.1% were male, and median age was 57 years. ACE-27 grading was none in 6.9% of patients, mild in 52.5%, moderate in 29.7%, and severe in 10.9%. Severe acute toxicities occurred more frequently in patients with moderate to severe comorbidities (75.6% versus 48.3%), with a statically significant difference ( p = 0.006, OR 3.314, 95%-CI (1.382–7.944)). In the group with moderate to severe comorbidities, omission of at least one cisplatin cycle (75.6% versus 60.0%) and premature ending of radiotherapy (12.2% versus 5.0%) also occurred more frequently ( p ≥ 0.05). Conclusion In patients with head and neck cancer treated with chemoradiotherapy, the presence of moderate to severe comorbidities seems to correlate with higher incidences of severe acute toxicities. ACE-27 may identify patients at higher risk of major toxicities and assist decisions regarding treatment.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-020-05679-4