Oral cavity squamous cell carcinoma in 260 patients aged 80years or more

Abstract 

Purpose

We report the experience of two French cancer centers in the treatment of oral cavity squamous cell carcinoma (SCC) in patients aged ⩾80years.

Materials and methods

Two hundred and sixty patients aged ⩾80years with a primary oral cavity SCC were included in this retrospective analysis.

Results

Sex ratio was near to 1. Tobacco or alcohol intoxication was the main risk factor for 66% of men and 16% of women and leukoplakia, lichen planus, or oral traumatism for 55% of women and 11% of men (p<0.0001). Two hundred patients received a loco-regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were initially planned to be adapted to age in 118 patients (59%). The median disease-specific survival (DSS) was 29months. In multivariate analysis, the independent prognostic factors for DSS were stage (HR=0.42 [0.24–0.72]), age (HR=0.43 [0.24–0.75]) and performance status (HR=0.50 [0.27–0.95]). The median overall survival (OS) was 14months. In multivariate analysis, the independent prognostic factors for OS were age (HR=0.52 [0.35–0.79]), stage (HR=0.56 [0.38–0.84]), tumor differentiation (HR=0.60 [0.33–0.93]) and performance status (HR=0.6 [0.37–0.97]). In patients treated with a curative intent, treatment adapted to age was not associated with a decreased overall survival or disease-specific survival as compared with the standard treatment. However, prophylactic lymph node treatment in stages I–II tumors decreased the rate of nodal recurrence from 38% to 6% (p=0.01).

Conclusion

This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer.

Keywords: Oral cavity, Squamous cell carcinoma, Elderly, Geriatric oncology, Radiotherapy, Surgery