Squamous Cell Carcinoma of the Head and Neck in the Elderly

Abstract

Abstract:Background: Increasing life expectancy and incidence of head and neck carcinomas, including some types of head and neck malignancies, lead to a constantly higher proportion of old oncologic patients. Previous reports regarding the outcome for elderly patients with head and neck carcinomas squamous cell carcinoma (HNSCC) are controversial. For further insight, a large single-institution material has been analysed.Material: Prospective recording of demographic details, continuous follow-up and determining exact cause of deaths of patients with carcinoma of the head and neck have been in progress over a period of 14 years. Having excluded 154 patients (7.3%), who did not follow-up, who had distant metastases at diagnosis, or who had received extensive treatment for a previous head and neck carcinoma or who refused treatment, or for medical or mental reasons, were unable to receive curative treatments. The material includes 1944 patients, of whom 37% received combined treatment, 58% radiotherapy alone and 6% surgery alone. The mean age was 65 years with a mean follow-up of 3.8 years. The material was divided into two groups; 65 and >65 years of age and analysed by means of X 2 tests and log-rank X 2 tests.Results: Early stage primary tumours and a more advantageous N-classification were more conspicuous among the older patients (p = 0.2406 and p<0.0002). The group of patients 65 years had a significantly better disease-specific survival rate compared to the older patients (p = 0.145). However, 40 % of the older patients were alive with no evidence of disease. By comparing 65-74 patients with patients' 76 years of age, a p-value of 0.0105 was obtained in favour of the younger group, but still an appreciable number of the older patients escaped their HNSCC. Conclusion:Given a satisfactory mental and physical condition, patients older than 65 years had a reasonable diseasespecific survival. It is therefore no reason to withhold appropriate treatment for the elderly, fit patients which could prevent or delay the misery and devastating situation, as well as a reduction in the heavy expenditures that patients with persistent or recurrent head and neck tumours represent.

Stereotactic Body Radiotherapy as Primary Therapy for Head and Neck Cancer in the Elderly or Patients with Poor Performance

“…For elderly patients with HNSCC or in younger patients with poor performance status, proper assessment of their medical conditions is critical in the initial workup. While elderly patients with good performance status should receive standard of care ( 12 ), those with multiple comorbidities who cannot tolerate standard therapy may benefit from a shortened, local consolidative treatment approach. Although definitive chemoradiation is associated with improved overall survival benefit ( 9 ), it comes at a price of substantial morbidity in a patient population with baseline multiple medical comorbidities due to the often long-term use of tobacco and excessive alcohol consumption ( 10 , 16 – 18 ).…”

“…The most commonly used radiation treatment regimen in elderly patients continues to be conventional fractionation of 180–200 cGy per fraction to a total dose of 7000 cGy. Several studies have demonstrated radiation treatment to be quite tolerable in the elderly population with high performance scores ( 11 , 12 ). When treating elderly patients with multiple comorbidities or dementia, however, life expectancy and performance status along with social issues become important factors that must be weighed into the treatment decision making process.…”