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Head and neck squamous cell carcinoma in elderly patients: a long-term retrospective review of 273 cases Sarini J; Fournier C; Lefebvre JL; Bonafos G; Van JT; Coche-Dequeant BArch Otolaryngol Head Neck Surg 2001[Sep]; 127 (9): 1089-92BACKGROUND: The prolongation of life expectancy results in an increasing number of malignant neoplasms occurring in the elderly population. For a long time these patients were not considered good candidates to receive aggressive therapy and probably were inadequately treated in many instances. OBJECTIVE: To assess the outcome of patients older than 74 years who had had head and neck squamous cell carcinoma. MATERIALS AND METHODS: In our database of 4610 consecutive patients with head and neck squamous cell carcinomas who were evaluated and treated at the Centre Oscar Lambret, Northern France Comprehensive Cancer Center, Lille, over a 10-year period (1974-1983), we identified 273 patients who were 75 years or older. The outcome was updated for all patients included in the database. RESULTS: A significantly higher proportion of females were noted in the older patient group (43/273, 15.8%) than in younger patient group (192/4337, 4.4%, P<.001). There were no differences for primary site except for hypopharyngeal squamous cell carcinoma that occurred less frequently in the elderly patients (8.8% vs 14.5%, borderline significance P =.02). There were no differences for TNM stage grouping, histological classification, incidences of previous cancer, and comorbidities. Surgery was performed in a smaller proportion of older patients (13.9% vs 27.4%, P<.001, for the primary site and 15.4% vs 35.6%, P<.001, for those occurring in the neck) as well as chemotherapy that was delivered in 5.5% vs 17.7% (P<.001). On the contrary, there was no difference in radiotherapeutic treatments. Tolerance to treatment was similar and there was the same proportion of persistent diseases 2 months after completion of the overall treatment (27.8% vs 25.4%, P =.94). Pooling local, regional, and distant failures and metachronous cancers, there was a borderline lower incidence in older patients (57.1% vs 64.2%, P =.02), which is explained by an obvious shorter life expectancy. If survival is not meaningful in such a comparison (5-year survival 23.8% vs 36.4%), then the causes of deaths may be compared. Among the 4067 patients who were dead at the last update, index tumor evolution-related deaths numbered 130 (48.1% of dead patients in this cohort) in older patients compared with 2045 (53.9% of dead patients in this cohort), which was not significantly different. There was no difference in treatment-related deaths (11.1% vs 9.3%). Fewer intercurrent disease-related deaths occurred in the older patients (19.7% vs 11.8%). CONCLUSIONS: Head and neck squamous cell carcinoma in elderly patients did not seem to have a significantly different outcome when compared with head and neck squamous cell carcinoma occurring in younger patients. When properly monitored, conventional therapies seem feasible in older patients.|Adolescent[MESH]|Adult[MESH]|Age Factors[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Carcinoma, Squamous Cell/mortality/*therapy[MESH]|Female[MESH]|Head and Neck Neoplasms/mortality/*therapy[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Retrospective Studies[MESH]|Survival Rate[MESH]|Time Factors[MESH]|Treatment Outcome[MESH] |
