The untreated patient with squamous carcinoma of the head and neck

Of 3,482 patients with head and neck squamous carcinoma, 539 were unsuitable for radical treatment. Patients over 60 years of age were 1.6 times more likely not to receive radical treatment than younger patients. Patients who were unfit [Eastern Cooperative Oncology Group (ECOG) 1-4] were 1.4 times more likely not to receive radical treatment than those who were generally well. Patients with advanced primary tumours (T3, T4) were twice as likely to be considered unsuitable for radical treatment as patients with small tumours. Patients with neck node metastases were 2.1 times more likely to be considered unsuitable for radical treatment compared with those without nodes. In addition, if neck nodes were present their site influenced the decision to treat radically. Patients with disease low in the neck were 1.3 times more likely to be considered unsuitable for radical treatment than those with disease high in the neck. Survival for untreated patients was dismal. The median tumour specific survival was 5 months, and the 5-year survival was 4%. In contrast the 5-year survival for treated patients was 60%. Cox's regression on untreated patients showed that advanced age, poor general condition, and advanced nodal disease all adversely affected survival.