Head and neck squamous cell carcinoma in elderly patients - A long-term retrospective review of 273 cases

Background: The prolongation of life expectancy results in an increasing nu mber of malignant neoplasms occurring in the elderly population. For a long time these patients were not considered good candidates to receive aggress ive therapy and probably were inadequately treated in many instances. Objective: To assess the outcome of patients older than 74 years who had ha d head and neck squamous cell carcinoma. Materials and Methods: In our database of 4610 consecutive patients with he ad and neck squamous cell carcinomas who were evaluated and treated at the Centre Oscar Lambret, Northern France Comprehensive Cancer Center, Lille, o ver a 10-year period (1974-1983), we identified 273 patients who were 75 ye ars or older. The outcome was updated for all patients included in the data base. Results: A significantly higher proportion of females were noted in the old er patient group (43/273, 15.8%) than in younger patient group (192/4337, 4 .4%, P<.001). There were no differences for primary site except for hypopha ryngeal squamous cell carcinoma that occurred less frequently in the elderl y patients (8.8% vs 14.5%, borderline significance P=.02). There were no di fferences for TNM stage grouping, histological classification, incidences o f previous cancer, and comorbidities. Surgery was performed in a smaller pr oportion of older patients (13.9% vs 27.4%, P<.001, for the primary site an d 15.4% vs 35.6%, P<.001, for those occurring in the neck) as well as chemo therapy that was delivered in 5.5% vs 17.7% (P<.001). On the contrary, ther e was no difference in radiotherapeutic treatments. Tolerance to treatment was similar and there was the same proportion of persistent diseases 2 mont hs after completion of the overall treatment (27.8% vs 25.4%, P=.94). Pooli ng local, regional, and distant failures and metachronous cancers, there wa s a borderline lower incidence in older patients (57.1% vs 64.2%, P=.02), w hich is explained by an obvious shorter life expectancy. If survival is not meaningful in such a comparison (5-year survival 23.8% vs 36.4%), then the causes of deaths may be compared. Among the 4067 patients who were dead at the last update, index tumor evolution-related deaths numbered 130 (48.1% of dead patients in this cohort) in older patients compared with 2045 (53.9 % of dead patients in this cohort), which was not significantly different. There was no difference in treatment-related deaths (11.1% vs 9.3%). Fewer intercurrent disease-related deaths occurred in the older patients (19.7% v s 11.8%). Conclusions: Head and neck squamous cell carcinoma in elderly patients did not seem to have a significantly different outcome when compared with head and neck squamous cell carcinoma occurring in younger patients. When proper ly monitored, conventional therapies seem feasible in older patients.