Age as a prognostic factor for head and neck squamous cell carcinoma: should older patients be treated differently?

In an aging society, one may expect to encounter more seniors with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to question the appropriateness of feasible aggressive curative treatment for these older patients.

A retrospective study.

A tertiary head and neck surgical oncology service.

A chart review of patients with HNSCC of the oral cavity, pharynx, and larynx, 75 years or older, who were primarily treated by our service from 1990 to 1999.

Demographics, pretreatment comorbidities and treatment modalities, and their related morbidity and mortality were reviewed. Special attention was given to treatment decision making and long-term outcome.

Twenty-six males and 14 females with an average age of 82.2 years were treated. Twenty-two had stage III and IV disease. All had at least one comorbidity. Four patients had palliative radiotherapy and were dead of disease within 6 months. Among the 36 patients who were treated for cure, there were 2 postoperative deaths, 11 recurrences, and 2 cases of distant metastasis. The average lifespan of the 34 survivors (until death or end of study) was 4.7 years.

HNSCC is a serious disease that often necessitates aggressive treatment. All of the patients who were medically eligible received curative treatment, with age not serving as an exclusion criterion. The average survival almost approached the expected lifespan of a normal cohort (4.7 vs 6.3 years, respectively). Seniors with HNSCC may benefit from curative treatment, and exclusion should be based, as for younger subjects, on an individual basis.