Management of elderly patients with locoregionally confined head and neck cancer

Abstract

Head and neck cancer in elderly patients represents a major health burden because its management provides unique and complex challenges for multidisciplinary teams, such as reduced treatment tolerance, multiple comorbidities, and altered pharmacokinetics and pharmacodynamics. Despite the prominent challenges involved, high-level evidence for the management of this group of patients is scarce. Substantial advances in treatment, such as robotic surgery, dynamic intensity-modulated radiation therapy, immunotherapy, and de-escalation trials, might allow for improved treatment tolerance in this patient population. Advanced age alone does not appear to be a contraindication to curative treatment. Evaluation of age-specific factors such as life expectancy, impaired functional status, and cognitive decline warrant consideration as part of the management decision process. In this Review, we provide an update of the available evidence on the management of locoregionally confined head and neck cancer in elderly patients and propose a practical treatment algorithm for clinicians to help manage this patient population.