Head and neck cancers in geriatric patients

Yıl 2009, Cilt: 19 Sayı: 1, 45 - 54, 01.02.2009

Ercihan Güney Sedat Çağlı İmdat Yüce

Öz

Cancer is a disease the incidence of which rises with age. Given that the risk of developing cancer increases with advancing age, a growing number of elderly patients will need treatment for cancer in the future, and head and neck surgeons are increasingly being faced with therapeutic dilemmas regarding this age group. Related publications show that older patients are less likely than younger patients to receive standard treatment. Therapeutical planning must be based not only on tumor characteristics, but also on the physiological, rather than the chronological, age of the patient. Comorbidity is the most important factor in less intensively treatment of elderly patients. Complete geriatric assessment and a multidisiclinary approach are the crucial points. Surgeons, radiation therapy specialists, medical oncologists and geriatricians must actively cooperate in this setting. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.

Anahtar Kelimeler

Comorbidity, geriatric, head and neck cancer

Yaşlılarda baş boyun kanserleri

Öz

Kanser yaş ilerledikçe görülme oranı artan bir has- talıktır. Bu, gelecekte daha fazla yaşlı hastanın kanser tedavisine gereksinimi olacağı ve baş boyun cerrahlarının bu yaş grubundaki tedavi ikilemleri ile daha fazla yüz yüze geleceği anlamına gelmektedir. İlgili literatür, yaşlı hastalarda gerekli standart teda- vinin genç hastalara oranla daha az uygulandığına işaret etmektedir. Esasen tedavi planı sadece tümör özelliklerine göre değil, hastanın kronolojik yaşından ziyade fizyolojik yaşı da dikkate alınarak yapılmalıdır. Yaşlı hastalarda daha az ekstansif tedavi uygulan- masının en önemli nedeni bu yaşlarda artan eşlik eden hastalıklardır. Tam geriatrik değerlendirme ve multidisipliner yaklaşım son derece önemlidir. Değerlendirmeye cerrahlar, radyasyon terapistleri, tıbbi onkologlar ve geriatri uzmanları aktif olarak katılmalıdır. Konu ile ilgili bilgilerimizi artırabilmek ve bu özellikli grupta optimum bir tedavi önerebilmek için yaşlı kanserli hastalarla ilgili daha fazla klinik çalışmalara ihtiyaç vardır

Anahtar Kelimeler

Komorbidite, yaşlılık, baş boyun kanseri

Kaynakça

• Kalache A, Keller I. Population ageing in develop- ing countries: demographic aspects. In: Evans JG, Williams TF, Beattie BL, Michel JP, Wilcoc GK, editors. Oxford textbook of geriatric medicine 2nd ed. New York: Oxford University Press; 2000. p. 26-32.
• Ramesh HS, Pope D, Gennari R, Audisio RA. Optimising surgical management of elderly cancer patients. World J Surg Oncol 2005;3:17.
• Monson K, Litvak DA, Bold RJ. Surgery in the aged pop- ulation: surgical oncology. Arch Surg 2003;138:1061-7.
• Metges JP, Eschwege F, de Crevoisier R, Lusinchi A, Bourhis J, Wibault P. Radiotherapy in head and neck cancer in the elderly: a challenge. Crit Rev Oncol Hematol 2000;34:195-203.
• Hirano M, Mori K. Management of cancer in the elder- ly: therapeutic dilemmas. Otolaryngol Head Neck Surg 1998;118:110-4.
• Kennedy BJ. Aging and cancer. J Clin Oncol 1988;6:1903- 11.
• Gourin CG, McAfee WJ, Neyman KM, Howington JW, Podolsky RH, Terris DJ. Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck. Laryngoscope 2005;115:1371-5.
• Sanabria A, Carvalho AL, Vartanian JG, Magrin J, Ikeda MK, Kowalski LP. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol 2007;14:1449-57.
• Gerson MC, Hurst JM, Hertzberg VS, Baughman R, Rouan GW, Ellis K. Prediction of cardiac and pulmo- nary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients. Am J Med 1990;88:101-7.
• Piccirillo JF. Importance of comorbidity in head and neck cancer. Laryngoscope 2000;110:593-602.
• Chen AY, Matson LK, Roberts D, Goepfert H. The sig- nificance of comorbidity in advanced laryngeal cancer. Head Neck 2001;23:566-72.
• Borggreven PA, Kuik DJ, Quak JJ, de Bree R, Snow GB, Leemans CR. Comorbid condition as a prognostic factor for complications in major surgery of the oral cavity and oropharynx with microvascular soft tissue reconstruction. Head Neck 2003;25:808-15.
• Derks W, de Leeuw RJ, Hordijk GJ. Elderly patients with head and neck cancer: the influence of comor- bidity on choice of therapy, complication rate, and survival. Curr Opin Otolaryngol Head Neck Surg 2005;13:92-6.
• Zabrodsky M, Calabrese L, Tosoni A, Ansarin M, Giugliano G, Bruschini R, et al. Major surgery in elderly head and neck cancer patients: immediate and long-term surgical results and complication rates. Surg Oncol 2004;13:249-55.
• Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol Head Neck Surg 2005;131:605-9.
• Piccirillo JF, Spitznagel EL Jr, Vermani N, Costas I, Schnitzler M. Comparison of comorbidity indices for patients with head and neck cancer. Med Care 2004;42:482-6.
• Audisio RA, Ramesh H, Longo WE, Zbar AP, Pope D. Preoperative assessment of surgical risk in oncogeriat- ric patients. Oncologist 2005;10:262-8.
• Bernardi D, Barzan L, Franchin G, Cinelli R, Balestreri L, Tirelli U, et al. Treatment of head and neck cancer in elderly patients: state of the art and guidelines. Crit Rev Oncol Hematol 2005;53:71-80.
• Yancik R, Ries LA. Cancer in older persons. Magnitude of the problem--how do we apply what we know? Cancer 1994;74:1995-2003.
• Barzan L, Veronesi A, Caruso G, Serraino D, Magri D, Zagonel V, et al. Head and neck cancer and ageing: a retrospective study in 438 patients. J Laryngol Otol 1990;104:634-40.
• Clayman GL, Eicher SA, Sicard MW, Razmpa E, Goepfert H. Surgical outcomes in head and neck cancer patients 80 years of age and older. Head Neck 1998;20:216-23.
• Laccourreye O, Brasnu D, Périé S, Muscatello L, Ménard M, Weinstein G. Supracricoid partial laryngectomies in the elderly: mortality, complications, and functional outcome. Laryngoscope 1998;108:237-42.
• Malata CM, Cooter RD, Batchelor AG, Simpson KH, Browning FS, Kay SP. Microvascular free-tissue trans- fers in elderly patients: the leeds experience. Plast Reconstr Surg 1996;98:1234-41.
• Shaari CM, Buchbinder D, Costantino PD, Lawson W, Biller HF, Urken ML. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998;124:407-11.
• Blackwell KE, Azizzadeh B, Ayala C, Rawnsley JD Octogenarian free flap reconstruction: complications and cost of therapy. Otolaryngol Head Neck Surg 2002;126:301-6.
• Pompei S, Tedesco M, Pozzi M, Varanese A, Barile A, Marzetti F. Age as a risk factor in cervicofacial recon- struction. J Exp Clin Cancer Res 1999;18:209-12.
• Baumann M. Is curative radiation therapy in elderly patients limited by increased normal tissue toxicity? Radiother Oncol 1998;46:225-7.
• Ampil FL, Mills GM, Stucker FJ, Burton GV, Nathan CO. Radical combined treatment of locally extensive head and neck cancer in the elderly. Am J Otolaryngol 2001;22:65-9.
• Lusinchi A, Bourhis J, Wibault P, Le Ridant AM, Eschwege F. Radiation therapy for head and neck cancers in the elderly. Int J Radiat Oncol Biol Phys 1990;18:819-23.
• Zachariah B, Balducci L, Venkattaramanabalaji GV, Casey L, Greenberg HM, DelRegato JA. Radiotherapy for cancer patients aged 80 and older: a study of effec- tiveness and side effects. Int J Radiat Oncol Biol Phys 1997;39:1125-9.
• Allal AS, Maire D, Becker M, Dulguerov P. Feasibility and early results of accelerated radiotherapy for head and neck carcinoma in the elderly. Cancer 2000;88:648- 52.
• Rudd GN, Hartley JA, Souhami RL. Persistence of cisplatin-induced DNA interstrand crosslinking in peripheral blood mononuclear cells from elderly and young individuals. Cancer Chemother Pharmacol 1995;35:323-6.
• Balducci L, Corcoran MB. Antineoplastic chemother- apy of the older cancer patient. Hematol Oncol Clin North Am 2000;14:193-212.
• Stein BN, Petrelli NJ, Douglass HO, Driscoll DL, Arcangeli G, Meropol NJ. Age and sex are indepen- dent predictors of 5-fluorouracil toxicity. Analysis of a large scale phase III trial. Cancer 1995;75:11-7.
• Schneider M, Thyss A, Ayela P, Gaspard MH, Otto J, Creisson A. Chemotherapy for patients aged over 80. In: Fentiman IS, Monfardini S, editors. Cancer in the elderly. New York: Oxford University Press; 1994. p. 53-60.
• Argiris A, Li Y, Murphy BA, Langer CJ, Forastiere AA. Outcome of elderly patients with recurrent or meta- static head and neck cancer treated with cisplatin- based chemotherapy. J Clin Oncol 2004;22:262-8.
• Oettle H, Riess H, Raguse JD, Bier J, Gath HJ. Recombinant human erythropoietin in the treat- ment of head and neck tumour anaemia. Int J Oral Maxillofac Surg 2001;30:148-55.
• Gebbia V, Di Marco P, Citarella P. Systemic chemo- therapy in elderly patients with locally advanced and/or inoperable squamous cell carcinoma of the head and neck: impact of anemia and role of recombi- nant human erythropoietin. Crit Rev Oncol Hematol 2003;48(Suppl):49-55.
• Schuchter LM, Hensley ML, Meropol NJ, Winer EP; American Society of Clinical Oncology Chemotherapy and Radiotherapy Expert Panel. 2002 update of recom- mendations for the use of chemotherapy and radio- therapy protectants: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol 2002;20:2895-903.