TREATMENT OF HEAD AND NECK CANCER IN THE ELDERLY FROM THE AGE OF EIGHTY

Emílio Tosto Neto MD, Terence Farias MD, MsC, PhD, Researcher Raphael Fernandes Calhau* MD, João Henrique Cunha Villela MD and Fernando Luiz Dias MD, MsC, PhD, FACS

ABSTRACT

Introduction: Brazilian population characteristics have been changing in the last decades. Senior population has been growing since the 1980s, resulting in changes of incidence and mortality rates. Objective: To describe the epidemiologic characteristics and prognostic factors of disease-free survival and overall survival in patients older than 80 years of age with head and neck cancer. Patients and methods: A retrospective study of 142 patients older than 80 years of age with head and neck cancer treated in the National Cancer Institute, Rio de Janeiro, Brazil (INCA-MS-RJ). Gender, age, stage, associated diseases, primary tumor site, treatment and outcome of the patients were analyzed. Statistical analysis was made considering the level of statistical significance when p < 0.05, using x2 test for univariate analysis and Cox regression for multivariate analysis. The analysis of the survival rate curves was performed with the Kaplan-Meyer method and compared with log rank test. Results: One hundred forty-two patients were studied, being 74 women (45%) and 78% men (55%). The mean age was 84.5 years (range, 80 – 94 years). The mouth was the most frequent site of the primary tumor, followed by oropharynx, larynx and hypopharynx. Most patients were in stage III (44 cases, 30.1%) and IV (64 cases, 45%). The squamous cell carcinoma was the most frequent histological type (93%). Thirty-four patients (23.9%) were not treated because they were not suitable for therapeutic approach. The most frequent treatment was the radiation therapy, with mean radiation dose of 51.4 Gy (6 – 70 Gy). We did not find any prognostic factor that could have influenced in disease-free survival. Maxillary sinus and hypopharynx tumors, advanced stage of disease, and the type of treatment performed had relationship with the increasing of mortality rates. Eighty-two (57.7%) patients died during the period of study. The mean disease-free survival was 11.93 months, and the mean overall survival was 16.18 months. Conclusion: The largest part of elderly people has oncologic disease detected in advanced stages (stages III and IV). No prognostic factor that could have influenced in disease-free survival was found. Maxillary sinus and hypopharynx tumors, advanced disease, and surgery combined with radiation therapy treatment were linked with increasing mortality rates. Increasing in survival was not observed with different types of treatment (surgery, radiation therapy or combined treatment), unless in early tumors, in which the radical treatment is more recommended.

Keywords: Maxillary sinus and hypopharynx tumors.