J Korean Med Sci.  2016 Aug;31(8):1300-1306. 10.3346/jkms.2016.31.8.1300.

Is There Any Age Cutoff to Treat Elderly Patients with Head and Neck Cancer? Comparing with Septuagenarians and Octogenarians

• Kim H
• Kim SD
• Shim YJ
• Lee SY
• Sung MW
• Kim KH
• Hah JH

• KMID: 2373760
• DOI: http://doi.org/10.3346/jkms.2016.31.8.1300

Abstract

With the increase in life expectancy, age is no longer considered as a limitation for treatment. Nevertheless, the treatment of elderly patients with head and neck cancer (HNC) remains controversial. Here, we aimed to review our experience with the treatment for elderly patients, while particularly focusing on the differences among older old patients (septuagenarians vs. octogenarians). We retrospectively reviewed the records of 260 elderly patients who were assigned to 3 groups according to age: 70 years old ≤ group 1 < 75 years old, 75 years old ≤ group 2 < 80 years old, and group 3 ≥ 80 years old. The patients were assessed for comorbidities using the Adult Comorbidity Evaluation (ACE)-27, and the American Society of Anesthesia (ASA) physical status was also compared. Group 1, 2, and 3, consisted of 97, 102, and 61 patients, respectively. No significant difference in demographic data was noted among the groups. However, group 3 showed more comorbidities than groups 1 and 2. With regard to the initial treatment for HNC, radiation therapy (RT) was more frequently performed in group 3 than in groups 1 and 2. Among 7 patients of non-compliant to treatment in group 3, 6 patients had have performed RT. In group 3, a total of 18 patients underwent surgery, including microvascular free flap reconstruction and no significant difference in complications was observed postoperatively compared with group 1 and 2. Moreover, no significant difference was noted in overall survival between the groups, regardless of the treatment modality chosen. In conclusion, octogenarians with HNC should be more carefully managed than septuagenarians with HNC. Surgical treatment can be considered in octogenarians with HNC, if it can be tolerated.

Keyword

Head and Neck Neoplasms; Geriatric Assessment; Surgical Procedures, Operative; Radiation Oncology

MeSH Terms

Age Factors
Aged
Aged, 80 and over
Comorbidity
Head and Neck Neoplasms/mortality/*radiotherapy/*surgery
Humans
Retrospective Studies
Survival Rate
Treatment Outcome

Figure

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  Fig. 1 The differences in treatment compliance ratios between septuagenarian and octogenarian head and neck cancer patients (Group 1: 70-75 years, Group 2: 76-80 years, Group 3: 80 years and older).

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  Fig. 2 The percentages of treatment modalities which were chosen for initial treatment for their head and neck cancer.

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  Fig. 3 Major and minor complications occurring within 1 week after surgery in elderly head and neck cancer patients.

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  Fig. 4 Overall survival of elderly patients with head and neck cancer (HNC) following therapeutic intervention. (A) Overall survival of patients who completed treatment for HNC, excluding patients who ceased during treatment. (B) Overall Survival of patients who underwent surgery for their HNC; Group 1 & 2 (septuagenarians) vs. Group 3 (octogenarians).

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