Treatment outcome of elderly patients (≥78 years) with head and neck squamous cell carcinoma: A single center experience

TL;DR

This study examines treatment outcomes for elderly patients with head and neck cancer, finding that surgery and specific radiotherapy approaches improve survival.

Contribution

The study provides evidence that curative treatments like radical surgery and hypofractionated radiotherapy benefit very elderly patients with head and neck cancer.

Findings

Radical resection improved survival compared to radiotherapy-based treatments (HR 0.362).

Radiotherapy doses over 60 Gy significantly increased median survival to 31 months.

Hypofractionated radiotherapy offers similar survival outcomes with shorter treatment duration.

Abstract

Patients older than the expected age of the local population generally have limited life expectancy. The optimal treatment approach for very elderly patients with head and neck cancer remains uncertain. This study retrospectively analyzed patients over 78 years old, the expected age in 2019 for Chinese individuals, who underwent treatment for head and neck cancer at a tertiary cancer center in China. The study compared the overall survival rates among different treatment groups. The findings revealed that among patients eligible for surgery, radical resection yielded better outcomes compared to radiotherapy-based treatments, with a hazard ratio (HR) of 0.362 (95% confidence interval [CI] 0.160–0.819, P ═ 0.015). Among patients who received radiotherapy, those who received a total dose exceeding 60 Gy had a significantly longer survival compared to those who received palliative doses, with a median survival time of 31 months vs 14 months (P ═ 0.003). Among 78 patients who underwent conventional fractionated radiotherapy (CFRT), 15 patients (19.23%) experienced unscheduled treatment breaks with a median duration of 12 days. However, these treatment breaks did not appear to impact survival (P > 0.1). The study also suggested that altered fractionated radiotherapy, including hypofractionated radiotherapy (hypo-RT), could be a viable alternative to CFRT, offering similar survival outcomes with reduced treatment duration. In conclusion, eligible patients should be treated with curative intent, even if they are older than the expected age of the local population. When radiotherapy is indicated, altered fractionation, particularly hypo-RT, may be a favorable option to consider.

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