Age ≥75 with ECOG ≥2, ≥2 comorbidities, weight loss >5%, or albumin <3.5 g/dL — concurren...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-HNSCC-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HNSCC`
Sources	`SRC-NCCN-NSCLC-2025` `SRC-ONCOKB`

Red Flag Origin

Definition	Age ≥75 with ECOG ≥2, ≥2 comorbidities, weight loss >5%, or albumin <3.5 g/dL — concurrent high-dose cisplatin chemoradiation poorly tolerated; consider weekly cisplatin, carboplatin, cetuximab + RT, or definitive RT alone with prophylactic gastrostomy.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age_years",
          "threshold": 75
        },
        {
          "any_of": [
            {
              "comparator": ">=",
              "finding": "ecog_status",
              "threshold": 2
            },
            {
              "comparator": ">=",
              "finding": "comorbidity_count",
              "threshold": 2
            }
          ]
        }
      ]
    },
    {
      "comparator": "<",
      "finding": "albumin_g_dl",
      "threshold": 3.5
    },
    {
      "comparator": ">",
      "finding": "weight_loss_percent",
      "threshold": 5
    }
  ],
  "type": "composite_clinical"
}

Notes

HNSCC patients are disproportionately tobacco / alcohol users with cardiopulmonary comorbidity and pre-treatment malnutrition. High-dose 3-weekly cisplatin (100 mg/m²) yields high renal / ototoxicity rates in elderly — Bonner cetuximab + RT (mAB-targeted) remains an option for cisplatin-ineligible. RTOG 1016 / De-ESCALaTE showed cetuximab + RT inferior to cisplatin + RT for HPV+ disease, so de-escalation should be cisplatin-ineligibility-driven, not HPV-driven. Pre-treatment swallowing evaluation, gastrostomy consideration, and dental clearance are mandatory in frail patients. Source-gap caveat: NCCN H&N / ESMO H&N not yet ingested as separate Source entities — using SRC-NCCN-NSCLC-2025 (adjacent thoracic / squamous reference per disease YAML precedent) and SRC-ONCOKB.

Used By

No reverse references found in the YAML corpus.