Treatment of Head and Neck Cancers in the Elderly

<p>　Japan's population is aging more rapidly than that of any other country. According to a publication by the Cabinet Office in 2015, 33 million people, or 26.0% of the population, are 65 years old or older, and this proportion is predicted to further increase. Naturally, the occurrence of cancers in elderly people is also likely to increase. Indeed, the percentage of patients with head and neck cancer who are 70 years old or older increased from 35.9% in 2003 to 40.8% in 2012 according to the head and neck cancer registry of the Japan Society for Head and Neck Cancer. Determining appropriate treatment methods is particularly difficult when treating elderly patients because the life expectancy of each patient varies greatly among individuals depending on their general decline in physiological function, the presence of comorbidities, and their social background. The greatest problem in the treatment of cancers in the elderly is the lack of evidence for the selection of therapeutic methods, even though various rating systems have been considered.</p><p></p><p>　We retrospectively reviewed all head and neck cancer patients age 75 years or older who received first-line treatment at Saitama Medical University International Medical Center between April 2007 and December 2014. Among the 348 eligible patients, the oral cavity was the most common tumor site, followed by the larynx, thyroid, hypopharynx, and oropharynx. Two hundred and thirty-eight patients received curative treatment, while 85 cases were treated palliatively. Among the 182 operations that were performed, 144 were curative resections, 30 were reconstructive operations (free flap), and 8 were palliative operations. Among the 67 patients who underwent radiotherapy, 50 patients underwent curative treatments. Chemoradiation was performed in 14 cases, all of which were curative. Eighty-five cases (81 palliative care and 4 palliative radiotherapy) chose palliative care.</p><p></p><p>　Postoperative complications were observed in 28 of the 174 patients. These complications included delirium in 7 patients (of which two had dementia prior to surgery) and heart failure in one patient. Among the 32 reconstructive operations, two cases required reoperations because of trouble with a free flap. The 5-year disease-specific survival rate for patients receiving curative treatment was 77.2%.</p><p></p><p>　Our results show that the outcome of curative treatment in elderly patients was comparable to that in non-elderly patients and that reconstructive operations can be successful in elderly patients as long as they are in good general condition. However, whether curative treatment should be selected needs to be determined on an individual basis after evaluating the patient's comorbidities, psychological condition, and expected quality of life after treatment.</p>