581 J. Bernier (ed.), Head and Neck Cancer: Multimodality Management , DOI 10.1007/978-1-4419-9464-6_41, © Springer Science+Business Media, LLC 2011 Abstract Elderly patients represent at least 40% o head and neck squamous cell carcinoma (HNSCC). These patients oten receive inadequate treatment, either exceeding their tolerance capability or exposing them to a lesser chance o cure because o undertreatment. Customizing treatment to the individual patient is the key or avoiding such pitalls. This paper analyses the literature on optimal management o elderly patients with HNSCC, rom the diagnostic proce- dures with a comprehensive geriatric assessment (CGA) o co-morbidities to the speciic recommendations or surgery, radiotherapy, and chemotherapy. Keywords Head and neck • Cancer • Elderly • Geriatric • Diagnostic • Treatment • Surgery • Radiotherapy • Chemotherapy Introduction The concept o elderly patient is highly questionable and denitely not closely linked to civil age. The median age or the diagnosis o invasive head and neck cancers is o about 60 years. More than 40% o head and neck cancers occur in patients older than 65 years [1]. Hence, the management o so-called “elderly patients” with head and neck cancer repre- sents a very common situation in our daily practice. This incidence o elderly people with head and neck cancer squamous cell carcinoma (HNSCC) will urther grow in the next decade due to several independent parameters: the con- stant increase o lie expectancy in most industrialized coun- tries, the limited ecacy o tobacco and alcohol prevention campaigns and growing emale incidence, and nally the medical awareness to provide a better quality o care to the geriatric population. Unortunately, as or other cancer types, most research trials have been using an upper age limit excluding patients over 65 or 70 years o age, thus leaving us with no evidence-based guidelines and a ew oten ill-dened recommendations or older patients’ age groups. This lack o evidence stresses the need or prospective studies with reliable assessment o patient’s co-morbidities aiming at well-dened treatment schedules including individually customized variations according to patient’s condition. Several conficting acts need some clarication: it seems logical to accept the statement that the number and severity o co-morbidities increase with age and interere with the choice o treatment and disease outcome. However, every year, more reports claim that head and neck cancer patients should be treated regardless o age when their general condi- tion is satisactory . Unortunately, there is an epidemiologic evidence that most elderly patients do not benet o the same chance o access to proper oncologic management as younger patients. The Specificity of the Elderly Head and Neck Cancer Patient By denition, the elderly patient with HNSCC has been exposed or a longer time to the main epidemiological ea- tures o such diseases: heavy tobacco and/or alcohol addic- tions with resulting co-morbidities, chronic obstructive broncho-pneumonitis, inection with various degrees or cardio-respiratory insuciencies, liver steatosis and cirrho- sis, poor oral hygiene and dental condition, ungal inections, malnutrition, weight loss, railty, low-perormance status, Wernicke’s encephalopathy, and associated neurological disorders. However, the degree o severity and combinations o co-morbidities widely dier rom a patient to another. They should not constitute a contra-indication to curative treatment unless they would expose the patient to a shorter lie expectancy than the spontaneous evolution o the malig- nant tumor. Moreover, a number o these co-morbidities are either ignored or insuciently controlled at the time o the diagnosis o cancer. The identication, systematic evalua- tion, and, whenever possible, correction o such conditions J.-C. Horiot ( *) Clinique de Genolier , Institut Multidisciplinair e d’Oncologie, 5 Route du Muids, Genolier CH-1272, Vaud, Switzerland e-mail: JCHORIOT @genolier.net Chapter 41 Treatment of the Elderly Head and Neck Cancer Patient Jean-Claude Horiot and Matti S. Aapro
