Treatment Approaches in Elderly Patients with Head and Neck Cancer

ISSN: 1875-5992 (Online)
ISSN: 1871-5206 (Print)


Volume 16, 12 Issues, 2016


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Anti-Cancer Agents in Medicinal Chemistry

Formerly: Current Medicinal Chemistry - Anti-Cancer Agents

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Michelle Prudhomme
Universite Blaise Pascal - C.N.R.S
Aubiere Cedex
France


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Treatment Approaches in Elderly Patients with Head and Neck Cancer



Anti-Cancer Agents in Medicinal Chemistry, 13(9): 1383-1390.

Author(s): Francesco Perri, Franco Ionna, Ettore Pavone, Francesco Longo and Francesco Caponigro.

Affiliation: National Tumor Institute of Naples, Head and Neck Medical Oncology Unit, Via Mariano Semmola – 80131 - Naples.

Abstract

Integration of geriatric assessment into cancer clinical practice is strongly needed in squamous cell carcinoma of the head and neck (SCCHN) due to the frequent discrepancy between chronologic and biologic age. Comprehensive Geriatric Assessment (CGA) is a multidimensional assessment tool that examines age-related domains. These parameters can be well assessed by easier tests such as Activity Daily Living and Instrumental Activity Daily Living for functional status; Charlson Comorbidity Index for comorbidity; Mini Mental State examination for cognitive status; Mini Nutritional Assessment for nutritional status; Beers criteria for concomitant drug assumption.

Early stage SCCHN is usually treated with either surgery or radiation therapy. Age is not an exclusion criteria for both modalities, but elderly patients have a higher complication rate. Patients with locally advanced SCCHN are preferably treated with concomitant cisplatin-radiotherapy, but the impact of chemotherapy on survival is lower with increasing patient age. The combination of cetuximab and radiation therapy can be a suitable option in elderly patients with locally advanced SCCHN. However, also in this group of patients, survival benefit is lower in elderly patients. Chemotherapy represents the mainstay of treatment in recurrent/metastatic SCCHN. However, elderly patients can receive more toxicity. Myelosuppression, diarrhea, mucositis, nephrotoxicity and neurotoxicity have to be early diagnosed and adequately treated.

The initial approach for screening elderly SCCHN patients may benefit from relatively easy tests such as Vulnerable Elders Survey 13 (VES-13), which can screen patients who are to undergo full CGA.


Keywords:

Activity daily living, beers criteria, biologic age, charlson comorbidity index, chemotherapy, chronologic age, comprehensive geriatric assessment, early stage squamous cell carcinoma of the head and neck, elderly patients, instrumental activity daily living, locally advanced squamous cell carcinoma of the head and neck, mini mental state examination, mini nutritional assessment, radiotherapy, recurrent/metastatic squamous cell carcinoma of the head and neck, surgery, toxicity, vulnerable elders survey.



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Article Details

Volume: 13
Issue Number: 9
First Page: 1383
Last Page: 1390
Page Count: 8
DOI: 10.2174/18715206113136660355
Price: $58
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