Radiotherapy for carcinomas of the head and neck in elderly patients

One fourth of patients with carcinomas of the head and neck present at the age of > or = 75 years, but tolerance and outcome of radiotherapy in this population is unknown from the literature. Our aim was to assess the overall survival rate in comparison to the survival probability of the normal population, and to document the efficacy of local treatment.

From 1980 to 1993, 75 patients aged 75 years or more (median 78.5 years) were treated with curative intent for carcinomas of the head and neck excluding the nasopharynx, paranasal sinuses, salivary glands and lips. Seventeen received postoperative radiotherapy, 58 were treated with radiotherapy alone. Early stage disease (T1 or T2 N0) was present in 26 patients, 27 patients presented with stage T3 and T4 any N. Eight patients received hyperfractionated radiotherapy to 74.4 Gy with 1.2 Gy twice daily. All others were treated with 1.8 to 2 Gy to a median total dose of 70 Gy in 6 to 8 weeks.

All but 6 patients completed radiotherapy. Local control at 3 years was 83% for early stage disease, and 39% for T3 and T4 tumors. Actuarial overall survival was 30% at 5 years, compared to 63% for age-matched male and 69% for female Swiss residents, respectively. The survival curve of the patients followed the curve of the normal population after a rapid drop in survival within the first 2 years. Median time to local relapse was 3 and 4 months, respectively, for early and advanced stages, and 6 months for glottic carcinomas. Except 1 case of bone necrosis, there was no severe late toxicity observed.

Although retrospective, the results suggest that the ultimate outcome in elderly patients with carcinomas of the head and neck is comparable to the course of the disease in younger patients.