Squamous Cell Carcinoma of the Head and Neck in the Elderly

Background: Increasing life expectancy and incidence of head and neck carcinomas, including some types of head and neck malignancies, lead to a constantly higher proportion of old oncologic patients. Previous reports regarding the outcome for elderly patients with head and neck carcinomas squamous cell carcinoma (HNSCC) are controversial. For further insight, a large single-institution material has been analysed. Material: Prospective recording of demographic details, continuous follow-up and determining exact cause of deaths of patients with carcinoma of the head and neck have been in progress over a period of 14 years. Having excluded 154 patients (7.3%), who did not follow-up, who had distant metastases at diagnosis, or who had received extensive treatment for a previous head and neck carcinoma or who refused treatment, or for medical or mental reasons, were unable to receive curative treatments. The material includes 1944 patients, of whom 37% received combined treatment, 58% radiotherapy alone and 6% surgery alone. The mean age was 65 years with a mean follow-up of 3.8 years. The material was divided into two groups; � 65 and >65 years of age and analysed by means of X 2 tests and log-rank X 2 tests. Results: Early stage primary tumours and a more advantageous N- classification were more conspicuous among the older patients (p = 0.2406 and p<0.0002). The group of patients � 65 years had a significantly better disease-specific survival rate compared to the older patients (p = 0.145). However, 40 % of the older patients were alive with no evidence of disease. By comparing 65-74 patients with patients' � 76 years of age, a p-value of 0.0105 was obtained in favour of the younger group, but still an appreciable number of the older patients escaped their HNSCC. Conclusion: Given a satisfactory mental and physical condition, patients older than 65 years had a reasonable disease- specific survival. It is therefore no reason to withhold appropriate treatment for the elderly, fit patients which could prevent or delay the misery and devastating situation, as well as a reduction in the heavy expenditures that patients with persistent or recurrent head and neck tumours represent.