Review on non-surgical treatment for elderly patients with locally advanced head and neck squamous cell carcinoma
He Shanshan1,2, Li Churong2, Chen Sihao1,2, Shao Shilong2,3, Zhong Zuxian2,4, Wang Dan1,2, Liu Yi1,2, Zhang Shichuan2,3
1College of Clinical Medicine, Southwest Medical University, Luzhou 646000, China; 2Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Sichuan Cancer Center, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu 610041, China; 3School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China; 4School of Clinical Medicine, Chengdu Medical College, Chengdu 610041, China
Abstract：With the aging of population, the elderly (≥65 years old) cancer patients have become one of the main populations for cancer care. For inoperable locally advanced head and neck squamous carcinomas, cisplatin-based concurrent chemoradiotherapy is the first-line choice. Several large clinical studies have shown that patients under 70 years of age can still benefit from concurrent chemoradiotherapy, while it should be cautious to apply chemotherapy to patients aged 70-80 years. For elderly patients who are intolerant to cisplatin, carboplatin or other regimens with less gastrointestinal and renal toxicity should be considered. Although anti-epidermal growth factor receptor (EGFR) monoclonal antibodies combined with radiotherapy has been proved to be more effective than radiotherapy alone in total patient population, age-subgroup analysis showed limited benefit in elderly patients. The safety of immune checkpoint inhibitors in elderly patients has been validated and those with high programmed death ligand-1 (PD-L1) expression may benefit from concurrent or neoadjuvant immunotherapy, however, high-level evidence is still lacking. For patients older than 80 years, radiotherapy alone may be superior to concurrent chemoradiotherapy, and hypofractionated radiotherapy for palliative purposes can be safely used in this population.
He Shanshan,Li Churong,Chen Sihao et al. Review on non-surgical treatment for elderly patients with locally advanced head and neck squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2023, 32(2): 169-173.
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