OROPHARYNGEAL CANCER IN THE ELDERLY

Purpose: The poor;prognosis of elderly patients in many cancers may be due to less thorough investigation and less aggressive treatment beca use of the perception that radical treatment will be poorly tolerated and that elderly patients have a limited life expectancy. We wished to assess whether older age is associated with (a) less radical treatmen t, (b) poorer outcome, or (c) greater toxicity, after adjusting for ot her possible contributing factors. Methods and Materials: A retrospect ive study of patients with loco-regional oropharyngeal cancer treated between January 1980 and December 1985 was conducted. Patients were tr eated with radiotherapy, surgery, chemotherapy, or combinations. Cox r egression was used to assess age effects while allowing for the influe nce of other factors. Results: Eighty-eight patients were treated radi cally and 16 palliatively. Treatment intent (radical or palliative) di d not appear to be related to age, before (p = 0.42) or after adjustin g for other factors (p = 0.34). In a selected group of 86 radically tr eated patients ages ranged from 33 to 85 (median 60). There were 35 lo co-regional failures and 58 deaths (38 related to oropharyngeal cancer ). Older patients were prescribed and received lower doses of radiatio n. However, older age was not related to the risk of loco-regional rec urrence (p = 0.96) or shorter survival (p = 0.67), and was not associa ted with duration of treatment interruption or severity of toxicity af ter adjustment for prognostic factors. There was some suggestion of a higher risk of recurrence with increasing age for patients under 70 ye ars but with a risk for patients over 70 at least equal to that of the youngest group. Elderly patients in our study may have been a selecte d group. Conclusion: Older patients with loco-regional oropharyngeal c ancer, or at least a subset of them, appear to be able to tolerate rad ical courses of radiotherapy, and to have similar outcomes as do young er patients.