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Management of Head and Neck Cancer in Elderly Patients

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Abstract

Head and neck cancer (HNC) represents a heterogeneous group of tumours requiring multimodality approaches. It is debatable whether HNC treatment in geriatric patients should be different to that delivered for younger patients. Furthermore, the risk of death seems to be higher in HNC patients with higher co-morbidity status. Despite the fact that there is no significant difference in outcome in younger versus older patients, older HNC patients are more likely to receive nonstandard, less aggressive therapies than younger patients. Age alone should not be the basis for selecting treatment options in older HNC patients. A thorough pretreatment evaluation of co-morbidities should always be performed, and radical surgical options should not be excluded in older HNC patients treated with curative intent, as postoperative complications occur no more frequently in older patients than in younger patients. Locoregional control and disease-free survival in older patients treated with radiation therapy (either with curative intent or in the palliative setting) are comparable to the results seen in younger HNC patients, with the same acute toxicity profile. In patients receiving systemic therapies, special attention must be given to modification of chemotherapy dosages according to renal and hepatic function. Molecular-targeted therapies appear to be very useful in such patients because of their favourable tolerability. In conclusion, once all physiological and biological risk factors have been addressed, a large proportion of geriatric patients can and should be offered the same HNC treatment as is offered to younger patients.

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Acknowledgements

Yassine Lalami and Gilberto de Castro Jr have participated equally in the writing of this manuscript. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Medical Oncology Clinic, Institut Jules Bordet, Boulevard de Waterloo, 121 - 3ème étage, 1000, Brussels, Belgium

    Yassine Lalami, Chantal Bernard-Marty &  Ahmad Awada

  2. Medical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil

    Gilberto de Castro Jr

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  1. Yassine Lalami
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Lalami, Y., de Castro, G., Bernard-Marty, C. et al. Management of Head and Neck Cancer in Elderly Patients. Drugs Aging 26, 571–583 (2009). https://doi.org/10.2165/11316340-000000000-00000

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