Squamous Cell Carcinoma of the Head and Neck in the Elderly

ABSTRACT

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.

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 X2 tests and log-rank X2 tests.

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.

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.