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Updated: Aug 5, 2025
Therapy Testing in a Spheroid-based 3D Cell Culture Model for Head and Neck Squamous Cell Carcinoma
Published on: April 20, 2018
Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer
Daniel R Dickstein1, Ann E Powers2, Dragan Vujovic1
1Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract:
Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.
Insights
Managing head and neck squamous cell carcinoma (HNSCC) in elderly patients requires careful consideration due to underrepresentation in trials. This review guides optimal work-up and treatment selection for older adults with HNSCC.
Area of Science:
- Oncology
- Geriatrics
Background:
- Head and neck squamous cell carcinoma (HNSCC) disproportionately affects elderly patients (approx. 30% are ≥70 years).
- Elderly individuals are underrepresented in clinical trials, leading to limited evidence-based management guidelines.
- Standard treatments like surgery and radiation therapy pose increased risks and challenges for older adults with comorbidities.
Purpose of the Study:
- To provide a comprehensive overview for approaching elderly patients with HNSCC.
- To guide clinicians in selecting appropriate treatment strategies for this population.
- To address the challenges and optimize outcomes in geriatric HNSCC management.
Main Methods:
- This is a review article, synthesizing existing knowledge and clinical considerations.
- It covers initial patient work-up, risk assessment, and treatment modality selection.
- Discussion includes challenges associated with surgery, radiation, and chemotherapy in older adults.
Main Results:
- Elderly patients with HNSCC face unique challenges due to comorbidities and potential treatment toxicities.
- Standard treatment regimens may lead to suboptimal outcomes, increased morbidity, or reduced quality of life in older adults.
- Ongoing clinical trials are exploring modified treatment approaches for this demographic.
Conclusions:
- Optimal management of HNSCC in elderly patients necessitates a personalized approach.
- Careful consideration of patient-specific factors, comorbidities, and treatment risks is crucial.
- Further research and clinical trials are needed to refine treatment strategies for geriatric HNSCC patients.
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