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Head and Neck Squamous Cell Carcinoma in Elderly Patients
A Long-term Retrospective Review of 273 Cases
Jerome Sarini, MD;
Charles Fournier;
Jean-Louis Lefebvre, MD;
Guillaume Bonafos, MD;
Jean Ton Van, MD;
Bernard Coche-Dequéant, MD
Arch Otolaryngol Head Neck Surg. 2001;127:1089-1092.
Background The prolongation of life expectancy results in an increasing number
of malignant neoplasms occurring in the elderly population. For a long time
these patients were not considered good candidates to receive aggressive therapy
and probably were inadequately treated in many instances.
Objective To assess the outcome of patients older than 74 years who had had head
and neck squamous cell carcinoma.
Materials and Methods In our database of 4610 consecutive patients with head and neck squamous
cell carcinomas who were evaluated and treated at the Centre Oscar Lambret,
Northern France Comprehensive Cancer Center, Lille, over a 10-year period
(1974-1983), we identified 273 patients who were 75 years or older. The outcome
was updated for all patients included in the database.
Results A significantly higher proportion of females were noted in the older
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 hypopharyngeal squamous cell carcinoma that occurred less frequently
in the elderly patients (8.8% vs 14.5%, borderline significance P = .02). There were no differences for TNM stage grouping, histological
classification, incidences of previous cancer, and comorbidities. Surgery
was performed in a smaller proportion of older patients (13.9% vs 27.4%, P<.001, for the primary site and 15.4% vs 35.6%, P<.001, for those occurring in the neck) as well as
chemotherapy that was delivered in 5.5% vs 17.7% (P<.001).
On the contrary, there was no difference in radiotherapeutic treatments. Tolerance
to treatment was similar and there was the same proportion of persistent diseases
2 months after completion of the overall treatment (27.8% vs 25.4%, P = .94). Pooling local, regional, and distant failures
and metachronous cancers, there was a borderline lower incidence in older
patients (57.1% vs 64.2%, P = .02), which 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% vs 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 properly monitored,
conventional therapies seem feasible in older patients.
From the Head and Neck Department (Drs Sarini, Lefebvre, Bonafos, Van,
and Coche-Dequéant), Biostatistics Unit (Mr Fournier), and Radiotherapy
Department (Dr Coche-Dequéant), Centre Oscar Lambret, Northern France
Comprehensive Cancer Center, Lille.
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Arch Otolaryngol Head Neck Surg. 2001;127(9):1146-1148.
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