Assessment of treatment tolerance and response of elderly head and neck cancer patients: A single institution retrospective study

Background: Head and neck (H and N) cancers are the leading cancer in elderly Indian population especially in Central India. Poor socioeconomic (SE) factors, lack of knowledge, and that of proper facilities is responsible for delayed presentation in advanced stages of the disease. Management of such patients is challenging for an oncologist. Aim: The present study evaluated the pattern of tolerance and response to treatment in elderly (>65 years) H and N cancer patients. Materials and Methods: Medical records of elderly H and N cancer patients presenting from January to December 2014 to the Department of Radiotherapy, Gandhi Medical College, Bhopal were reviewed, and data were collected from the departmental case files. Results: A total 112 patients were selected for this study. The mean age of presentation was 70 years. There was a marked male preponderance, with male to female ratio of 5.22:1. 102 patients presented in advanced stages (stage III and IV). The mean duration of symptoms was 6.5 months. Records of 99 patients were available and further analyzed. 59 patients were advised three courses of induction chemotherapy (CT) out of which 44 patients completed the treatment. 28 of these patients showed a positive response to the treatment while 16 showed no response (NR)/progression. Similarly, 24 patients were advised concurrent chemoradiotherapy out of which 17 patients completed the treatment. 13 of these patients showed a positive response while 04 showed NR/progression. On subgroup analysis, the difference between tolerance, response and overall treatment time between the two arms was not statistically significant. Conclusions: Treating elderly H and N cancer patients is a major therapeutic challenge for a clinician because of its poor prognosis, aggressive clinical behavior, associated co-morbidities, and SE factors. However, it is possible to achieve a quality outcome in select patients with basic CT and radiation.