This retrospective analysis assessed the prognostic impact of the G8 geriatric screening tool in patients with head and neck squamous cell carcinoma (HNSCC) who were ineligible for cisplatin and therefore received concurrent radiotherapy (RT) with cetuximab. The cohort comprised 52 patients treated between 2011 and 2024. Patients with p16-positive oropharyngeal or nasopharyngeal cancers were excluded. Median follow-up reported in the source was 50 months.
Investigators evaluated overall survival (OS) and cancer-specific survival (CSS) according to G8 and Charlson Comorbidity Index (CCI) scores. Analyses included receiver operating characteristic (ROC) curves to define a G8 cut-off, Kaplan–Meier survival estimates, and Cox proportional hazards regression to identify independent predictors of outcome. The study population consisted specifically of cisplatin-ineligible patients receiving RT plus cetuximab for locally advanced or loco-regional recurrent disease.
ROC analysis identified a G8 threshold of 9.75 as the optimal cut-off for prognostic discrimination. The area under the curve (AUC) for this cut-off was 0.713 with p < 0.01, supporting the discriminatory performance of the G8 score in this cohort.
Survival differed markedly by G8 category. Patients with G8 ≥ 9.75 experienced substantially better outcomes than those with G8 < 9.75. Median overall survival among high-G8 patients was 47 months versus 7 months for low-G8 patients (p < 0.01). Four-year cancer-specific survival was 66% in the G8 ≥ 9.75 group compared with 32% in the G8 < 9.75 group (p < 0.01). These differences indicate a strong association between higher G8 scores and improved survival in cisplatin-ineligible HNSCC patients treated with RT and cetuximab.
The study reported subgroup analyses by treatment intent. In the definitive treatment subgroup, 4-year CSS was 68% for patients with G8 ≥ 9.75 versus 42% for those with lower G8 scores. In the loco-regional recurrence subgroup, 4-year CSS was 63% among patients with high G8 scores; the source states that no patient with a low G8 score survived beyond four years in the recurrence group. These subgroup findings reinforce the prognostic relevance of the G8 score across different clinical contexts within the cisplatin-ineligible population.
On multivariate Cox regression, two variables emerged as independent predictors of poorer overall survival: G8 < 9.75 (hazard ratio 4.72, p < 0.01) and RT dose < 60 Gy (hazard ratio 3.01, p = 0.01). These results indicate that both lower geriatric screening scores and lower delivered radiotherapy dose were independently associated with increased mortality risk in this dataset.
The Charlson Comorbidity Index (CCI) was evaluated but did not show a statistically significant association with survival outcomes in this cohort, according to the source. The study therefore highlights a stronger prognostic signal for the G8 geriatric screening tool than for the CCI in cisplatin-ineligible patients managed with RT and cetuximab.
Within the limits of a retrospective study of 52 patients, the source concludes that the G8 score is a valuable prognostic tool for cisplatin-ineligible HNSCC patients treated with radiotherapy and cetuximab. Low G8 scores identified a high-risk subgroup with markedly worse median OS and lower 4-year CSS, suggesting that these patients may warrant consideration of alternative therapeutic strategies or intensified supportive care. The authors also identified RT dose < 60 Gy as an independent predictor of poor overall survival. The CCI did not predict outcomes in this analysis.
Limitations reported in the source include the retrospective design and the cohort size. Further details beyond those included in the abstract were not provided in the source text. Future prospective validation of the G8 cut-off and exploration of tailored treatment approaches for low-G8 patients were implied by the findings but not specified in the source.