{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:38:56Z","timestamp":1787499536342,"version":"build-2736575974"},"reference-count":124,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The standard of care for locally advanced head and neck cancer is concurrent chemoradiation or postoperative irradiation with or without chemotherapy. Surgery may not be an option for older patients (70 years old or above) due to multiple co-morbidities and frailty. Additionally, the standard chemotherapy of cisplatin may not be ideal for those patients due to oto- and nephrotoxicity. Though carboplatin is a reasonable alternative for cisplatin in patients with a pre-existing hearing deficit or renal dysfunction, its efficacy may be inferior to cisplatin for head and neck cancer. In addition, concurrent chemoradiation is frequently associated with grade 3\u20134 mucositis and hematologic toxicity leading to poor tolerance among older cancer patients. Thus, a new algorithm needs to be developed to provide optimal local control while minimizing toxicity for this vulnerable group of patients. Recently, immunotherapy with check point inhibitors (CPI) has attracted much attention due to the high prevalence of program death-ligand 1 (PD-L1) in head and neck cancer. In patients with recurrent or metastatic head and neck cancer refractory to cisplatin-based chemotherapy, CPI has proven to be superior to conventional chemotherapy for salvage. Those with a high PD-L1 expression defined as 50% or above or a high tumor proportion score (TPS) may have an excellent response to CPI. This selected group of patients may be candidates for CPI combined with modern radiotherapy techniques, such as intensity-modulated image-guided radiotherapy (IM-IGRT), volumetric arc therapy (VMAT) or proton therapy if available, which allow for the sparing of critical structures, such as the salivary glands, oral cavity, cochlea, larynx and pharyngeal muscles, to improve the patients\u2019 quality of life. In addition, normal organs that are frequently sensitive to immunotherapy, such as the thyroid and lungs, are spared with modern radiotherapy techniques. In fit or carefully selected frail patients, a hypofractionated schedule may be considered to reduce the need for daily transportation. We propose a protocol combining CPI and modern radiotherapy techniques for older patients with locally advanced head and neck cancer who are not eligible for cisplatin-based chemotherapy and have a high TPS. Prospective studies should be performed to verify this hypothesis.<\/jats:p>","DOI":"10.3390\/cancers14215285","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T20:37:58Z","timestamp":1666903078000},"page":"5285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group"],"prefix":"10.3390","volume":"14","author":[{"given":"Nam P.","family":"Nguyen","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyndon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4755-496X","authenticated-orcid":false,"given":"Juliette","family":"Thariat","sequence":"additional","affiliation":[{"name":"Francois Baclesse Cancer Center, 14000 Caen, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-4654","authenticated-orcid":false,"given":"Brigitta G.","family":"Baumert","sequence":"additional","affiliation":[{"name":"Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thandeka","family":"Mazibuko","sequence":"additional","affiliation":[{"name":"International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olena","family":"Gorobets","sequence":"additional","affiliation":[{"name":"Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, 97213 Le Lamentin Martinique, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6403-6120","authenticated-orcid":false,"given":"Vincent","family":"Vinh-Hung","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, 98716 Pirae, Tahiti, French Polynesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Giap","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahir","family":"Mehmood","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Northampton General Hospital, Northampton NN1 5BD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Vincent","sequence":"additional","affiliation":[{"name":"Department of Surgery, Southern Regional Health System-Lawrenceburg, Lawrenceburg, TN 38464, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Chi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Beijing Chest Hospital, Beijing 101149, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trinanjan","family":"Basu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, HCG Cancer Center Borivali, and HCG ICS, Mumbai, Maharashtra 400092, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokoulakrichenane","family":"Loganadane","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, CHU Mondor, 94000 Creteil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Mohammadianpanah","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Karlsson","sequence":"additional","affiliation":[{"name":"International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eromosele","family":"Oboite","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan","family":"Oboite","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Hematology Oncology, Howard University, Washington, DC 20059, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandi R.","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21093, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1002\/(SICI)1097-0347(199710)19:7<567::AID-HED2>3.0.CO;2-5","article-title":"A phase III randomized trial comparing concurrent chemotherapy and radiotherapy with radiotherapy alone in resectable head and neck cancer","volume":"19","author":"Adelstein","year":"1997","journal-title":"J. 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