Should older head and neck patients be treated differently?

ObjectivesGrowing life expectancy is resulting in an increasing number of elderly patients with upper aero digestive tract tumor. The objective of this study was to assess the appropriateness of aggressive curative treatment for these older patients.Patients and MethodsPatients over the age of 70 years, with head and neck squamous cell carcinoma (HNSCC) of the oral cavity, pharynx or larynx, primarily treated in our department between 2005 and 2007, were assessed retrospectively at 36 months’ follow-up. Demographics, comorbidity and treatment strategies and their associated morbidity and mortality were reviewed.ResultsThirty-two males and 12 females with a median age of 77 years (range, 70–88 yrs) were given curative treatment. The majority presented with a least one comorbidity. Seven had a history of myocardial ischemia, 15 of chronic obstructive bronchopathy, and 10 of type-2 diabetes; 17 were under treatment for arterial hypertension, four had chronic renal insufficiency, and two had cirrhosis. Nine patients received radiation therapy alone; 18, concomitant chemoradiotherapy; 14, surgery with adjuvant chemoradiotherapy; three were treated by salvage surgery after failure of radiation therapy. In the 44 patients, there were 12 deaths: seven from recurrence, two from treatment complications, one from MI, one from peritonitis and one from pneumonia. At 36 months’ follow-up, 32 of the 44 patients were alive.ConclusionHNSCC is a serious disease that often necessitates aggressive treatment. All patients who are medically eligible should receive curative treatment, without age being an exclusion criterion. Taking comorbidity into account, on the other hand, enables treatment options to be optimized.