Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
Department of Medical Oncology, The Canberra Hospital, Garran ACT 2605, Australia.
J Geriatr Oncol. 2018 Jul;9(4):411-417. doi: 10.1016/j.jgo.2018.03.016. Epub 2018 Jun 9.
Managing older patients with head and neck cancers poses a challenge due to the often reduced levels of physiological reserve, the frequent comorbidities and treatment related toxicity. These factors have implications on speech, breathing and swallowing functions. Treatment management plans in these patients may result in de-intensification strategies and as a result of this, use of non-standard treatments is increasing. There have been published reports that indicate the addition of concurrent systemic therapy to radiation in selected older patients is feasible, and produces outcomes comparable with younger patients. However, some other studies including meta-analyses suggest a lack of real survival benefit with the addition of chemotherapy. So, the key point appears to be the optimal patient selection. Appropriate geriatric and frailty assessments are required to help determine the optimal treatment for older patients with head and neck cancer. Treatment for this population still needs to be well defined and optimized in both modality and intensity. Qualitative studies are also required to address short and long-term post-treatment quality-of-life and survivorship issues in this specific patient population. This review summarizes the evidence available regarding the non-surgical management of older patients with head and neck cancers.
管理老年头颈部癌症患者具有挑战性，因为他们的生理储备水平常常较低，经常合并多种疾病，并且与治疗相关的毒性反应也较为频繁。这些因素会影响到他们的言语、呼吸和吞咽功能。这些患者的治疗管理计划可能需要采用减量化策略，因此，非标准治疗的应用正在增加。有一些已发表的报告表明，在某些老年患者中，将同期的全身性治疗添加到放疗中是可行的，并且可以获得与年轻患者相当的结果。然而，其他一些研究，包括荟萃分析，表明添加化疗并没有真正的生存获益。因此，关键似乎在于进行最佳的患者选择。需要进行适当的老年和虚弱评估，以帮助确定老年头颈部癌症患者的最佳治疗方法。对于这部分人群，治疗方案在方式和强度上仍需要进一步明确和优化。还需要进行定性研究，以解决该特定患者群体在短期和长期治疗后的生活质量和生存问题。本综述总结了有关老年头颈部癌症患者非手术治疗的现有证据。
