THERAPEUTIC OPTIONS FOR ELDERLY PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCERS: PRINCIPLES OF GERIATRIC ONCOLOGY

Camil Ciprian Mireștean, Roxana Irina Iancu, Dragoș Petru Teodor Iancu

DOI : 10.62610/RJOR.2025.2.17.62

ABSTRACT

Head and neck locally advanced cancers are frequently diagnose in older adults and the proportion of these cases increases simultaneously with life expectancy, generally being frail patients with multiple comorbidities and poly-medication. The risk that evolution of these geriatric patients, poorly represented in clinical trials, will worsen as result of the administration of a standard treatment makes it necessary to refine the selection criteria and adapt the therapies to maximize the benefit/risk ratio (tumor control/toxicities). Currently, the standard for these cases is chemo-radiotherapy as a definitive treatment the outcome is often marked by severe treatment related adverse effects (AEs). The administration of maximal treatment with concurrent radio-chemotherapy determines frequent interruptions or even discontinuations of treatment. Patient selection strategies based on geriatric assessment scales, the use of Cetuximab as an alternative to Cisplatin, moderately hypo-fractionated and split course radiotherapy regimens could be potentially curative alternative to a purely palliative treatment. It is necessary to evaluate in prospective studies the possibility of concurrent treatment with immunotherapy and modern radiotherapy techniques, in moderately hypo-fractionated regimens for cases of elderly patients with multiple comorbidities, ineligible for standard radio-chemotherapy.