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Management of head and neck cancer in elderly patients
Drugs & Aging, 08/12/09
Lalami Y et al. – In a review of the management of head and neck cancer (HNC) in elderly pts, it was concluded that once all physiological and biological risk factors have been addressed, a large proportion of geriatric pts can and should be offered the same HNC treatment as is offered to younger pts.
Methods- HNC represents a heterogeneous group of tumours requiring multimodality approaches.
- It is debatable whether HNC treatment in geriatric pts should be different to that delivered for younger pts.
- Risk of death seems to be higher in HNC pts with higher co-morbidity status.
- Despite the fact that there is no significant difference in outcome in younger vs older pts, older HNC pts are more likely to receive nonstandard, less aggressive therapies than younger pts.
- Age alone should not be the basis for selecting treatment options in older HNC pts.
- A thorough pretreatment evaluation of co-morbidities should always be performed, and radical surgical options should not be excluded in older HNC pts treated with curative intent, as postoperative complications occur no more frequently in older pts than in younger pts.
- Locoregional control and disease-free survival in older pts treated with radiation therapy are comparable to the results seen in younger HNC pts, with the same acute toxicity profile.
- In pts receiving systemic therapies, special attention must be given to modification of chemotherapy dosages according to renal and hepatic function.
- Molecular-targeted therapies appear to be very useful in such pts because of their favourable tolerability.
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