Medical Oncology Clinic, Institut Jules Bordet, Brussels, Belgium.
Drugs Aging. 2009;26(7):571-83. doi: 10.2165/11316340-000000000-00000.
Head and neck cancer (HNC) represents a heterogeneous group of tumours requiring multimodality approaches. It is debatable whether HNC treatment in geriatric patients should be different to that delivered for younger patients. Furthermore, the risk of death seems to be higher in HNC patients with higher co-morbidity status. Despite the fact that there is no significant difference in outcome in younger versus older patients, older HNC patients are more likely to receive nonstandard, less aggressive therapies than younger patients. Age alone should not be the basis for selecting treatment options in older HNC patients. A thorough pretreatment evaluation of co-morbidities should always be performed, and radical surgical options should not be excluded in older HNC patients treated with curative intent, as postoperative complications occur no more frequently in older patients than in younger patients. Locoregional control and disease-free survival in older patients treated with radiation therapy (either with curative intent or in the palliative setting) are comparable to the results seen in younger HNC patients, with the same acute toxicity profile. In patients 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 patients because of their favourable tolerability. In conclusion, once all physiological and biological risk factors have been addressed, a large proportion of geriatric patients can and should be offered the same HNC treatment as is offered to younger patients.
头颈部癌症（HNC）是一组异质性肿瘤，需要采用多模式方法进行治疗。对于老年患者的 HNC 治疗是否应与年轻患者有所不同，这一点存在争议。此外，合并症状态较高的 HNC 患者死亡风险似乎更高。尽管年轻患者与老年患者的结局无显著差异，但老年 HNC 患者接受非标准、侵袭性较小的治疗方案的可能性高于年轻患者。在选择老年 HNC 患者的治疗方案时，不应仅以年龄为依据。应始终对头颈部癌症患者的合并症进行全面的治疗前评估，并且不应排除根治性手术方案，因为与年轻患者相比，老年患者术后并发症的发生率并不更高。对于接受根治性或姑息性放疗的老年患者，局部区域控制和无疾病生存与年轻 HNC 患者的结果相当，且具有相同的急性毒性特征。对于接受系统治疗的患者，必须特别注意根据肾功能和肝功能调整化疗剂量。由于分子靶向治疗具有良好的耐受性，因此对于此类患者非常有用。总之，一旦解决了所有生理和生物学危险因素，很大一部分老年患者可以并且应该接受与年轻患者相同的 HNC 治疗。
