Abstract
Simple SummaryThe focus of this review deals with the management of elderly patients with head and neck squamous cell carcinoma, discussing the role of clinical management, geriatric evaluation and therapeutic approaches (radiation therapy and systemic therapies).Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, with approximately 25–40% of the diagnosed patients older than 70 years. HNSCC patients are often frail and frequently have multiple comorbidities due to their unhealthy lifestyle, and evidence suggests that older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status. The aim of this review is to depict and summarize the evidence regarding the different strategies that can be used in the clinical management of elderly HNSCC patients. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This paper contains a narrative report and a critical discussion of clinical approaches in the context of elderly HNSCC.
Highlights
Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, representing approximately 6% of all new cancer cases
In the choice of treatment, it is important to evaluate some characteristics both related to the patient, and features related to the tumor (TNM stage, tumor grading, debulking or curative strategies) as age may not affect the tolerability profile of treatment and denying standard therapy to elderly patients only on the basis of age may not be entirely justified
An Italian survey by AIRO on elderly HNSCC patients showed that while the majority of cases were discussed in a multidisciplinary setting, a geriatrician was rarely part of the MDT, and comprehensive geriatric assessment was performed in only 10% of radiotherapy-oncology departments, risking under or overtreatment due to wrong frailty assessments [17]
Summary
Head and neck squamous cell carcinomas (HNSCC) constitute the sixth most common malignancy worldwide, representing approximately 6% of all new cancer cases. There is evidence that older patients with HNSCC may receive less aggressive and suboptimal treatment than younger patients with the same disease status [1] For this reason, in the choice of treatment, it is important to evaluate some characteristics both related to the patient (performance status, comorbidity or symptoms related to the disease, life expectancy, compliance to treatment), and features related to the tumor (TNM stage, tumor grading, debulking or curative strategies) as age may not affect the tolerability profile of treatment and denying standard therapy to elderly patients only on the basis of age may not be entirely justified. Age-related biological changes cause a decline in multiple physiological functions For this reason, decision making on treatment in older patients requires multidisciplinary evaluation and risk assessment. It is evident that finding a balance between intensive treatment and therapeutic nihilism is essential in elderly patients [2]
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