Published online Feb 10, 2015. doi: 10.5306/wjco.v6.i1.7
Peer-review started: November 12, 2013
First decision: December 2, 2013
Revised: December 18, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: February 10, 2015
Head and neck cancer (HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.
Core tip: Elderly patients with head and neck cancer represent an increasing but frail patient group that require the implementation of multidisciplinary therapeutic approaches. Organ-sparing modern surgical techniques, sophisticated radiotherapy and novel chemotherapeutic and molecular targeted drug combinations enable delivery of optimal treatment in an effort to minimize toxicity without compromising efficacy.