We have been applying superselective intra-arterial chemotherapy (SIC) by using the Seldinger technique as the treatment strategy for maxillary sinus carcinoma since 1998 in combination with radiotherapy and surgery. SIC allows delivery of high-dose anticancer drugs to the target tumor at high concentrations through its feeding vessel with few adverse effects by neutralizing and limiting the toxic effects of CDDP within an acceptable range. We studied the effect of primary treatment and adverse events in 40 patients with squamous cell carcinoma of the maxillary sinus who underwent high-dose SIC combined with radiotherapy in our department between 1998 and 2008. The patients were 30 men and 10 women aged 43 to 75 years (median, 61 years). All carcinomas were advanced and graded as T3 in 17, T4 in 23, and N+ in 8. Some of the carcinomas reached the skull base or extended deep into the orbit. SIC was performed using the Seldinger technique from the femoral artery. Total CDDP dose was 200-300 mg/m² (mean, 210 mg/m²). All vessels used for the treatment were those branching from the external carotid arteries; those from internal carotid arteries were not used for intra-arterial infusion. Following arterial infusion chemotherapy, systemic administration of 800 mg 5-FU was started on Day 2. Simultaneous radiotherapy was started on Day 2 at a dose of 2 Gy with a goal of increasing up to 60 Gy. Patients enrolled in this treatment arm received two courses of chemotherapy at 1- to 2-week intervals, along with a total dose of 60 Gy of radiotherapy from 1998 to 2007. Since 2008, two courses of SIC with the Seldinger technique, based on the results of postoperative pathological examination, and curative radiation at 60 Gy became the preferred basic treatment strategy irrespective of tumor size, and evaluation of treatment response at the level of 40 Gy was abandoned. For residual or recurrent carcinoma, we took a “wait & see” approach and conducted salvage operation as additional treatment. Adverse events of chemotherapy and SIC combined with radiotherapy were completed as scheduled. The treatment response was evaluated at 1 month based on macroscopic, imaging, and histopathological findings. In total, the Seldinger technique was performed 73 times in 40 patients. The mean number of feeding vessels used for treatment was 2.3. Follow-up of adverse events revealed Grade 3 or higher stomatitis in 45% of patients; although it often led to anorexia or dysphagia, it was reversible in all cases. Five patients needed G-CSF administration for leukocytopenia. Grade 3 or higher renal dysfunction related to CDDP administration was observed in 6 patients. Three patients underwent hemodialysis for Grade 4 renal dysfunction and all could discontinue hemodialysis. All adverse events were reversible and non-serious except for 3 patients with suspected symptoms of transient cerebral ischemia. Primary treatment response was CR in 50.0% and PR in 25.0% at 40 Gy, with a response rate of 75.0%. Thirty patients received surgery after intra-arterial chemotherapy. Of these, 10 patients rated as CR before surgery were all pathological CR. Of 10 patients who achieved PR in their primary treatment response after SIC combined with radiotherapy, 5 patients were pathological CR in the postoperative pathological evaluation. The final CR rate was 62.5%. These results suggest that adverse events of this therapy are relatively minor and within an acceptable range. In terms of local control, SIC may avoid invasive surgical procedures.

View full abstract

Background: Current goals for the treatment of maxillary sinus carcinoma include preservation of vision, eating, communication, and appearance as well as cure.
Methods: 121 Japanese patients who presented with maxillary sinus carcinoma between 1979 and 2005 were analyzed retrospectively. There were 77 males and 44 females, with a median age of 63 years. All patients underwent multimodality therapy including surgery through a sublabial incision, radiotherapy, and intra-arterial chemotherapy. The regional lymph nodes were treated only in patients with neck involvement.
Results: Mean follow-up period was 79 months. The 5-year overall survival rate and local control rate were 73% and 72%, respectively. The 5-year local control rate was 70% for patients with T2 lesions, 86% for patients with T3 lesions, 55% for patients with T4a lesions, and 52% for patients with T4b lesions. In patients with squamous cell carcinoma, the 5-year local control rate was 76%. In patients with non-squamous cell carcinoma, the 5-year local control rate was 54%. There was a significant difference in local control rates among these groups.
Conclusions: Control of the primary site is important in the curative treatment of maxillary sinus carcinoma. Combined therapy with conservative surgery, radiotherapy, and regional chemotherapy is effective for this carcinoma.

View full abstract

We report the treatment and clinical results for squamous cell carcinoma of the maxillary alveolus and hard palate.
Fifty-nine cases with squamous cell carcinoma of the maxillary alveolus and hard palate treated between April 2001 and March 2009 were reviewed. For the initial treatment, 3 patients received brachytherapy, 43 patients underwent surgical resection alone, and 13 patients underwent surgical resection combined with radiotherapy or chemoradiotherapy.
Local failure developed in 11 patients (18.6%), of which 7 patients were salvaged with further surgery. Five-year cumulative survival rates were 89.1% for all patients, 93.9% for the surgery-alone group and 71.3% for the preoperative treatment group. Further study is necessary to decide the optimal strategy and indications for preoperative treatment.
Cervical lymph node metastasis was histologically confirmed in 16 patients (27.1%). Contralateral cervical lymph node metastasis developed in 8 patients. Five-year cumulative survival rates were 94.0% for pN0, 83.3% for pN1 and pN2b, and 70.0% for pN2c patients. Metastasis to the contralateral cervical lymph node should be considered in patients with maxillary alveolus and hard palate carcinoma.

View full abstract

AIM: Narrow band imaging (NBI) as a novel endoscopy system can be used to detect oro- and hypopharyngeal squamous cell carcinoma (SCC) at an early stage. However, much remains unknown about the endoscopic features of oro- and hypopharyngeal tumors including superficial SCC and dysplasia. This study aimed to reveal the endoscopic features and their clinical implications.
METHODS: This was a prospective, single-center study. A total of 203 oro- and hypopharyngeal lesions from 148 patients were observed by conventional gastrointestinal endoscopy (CGE) and non-magnified / magnified NBI gastrointestinal endoscopy (NBGE), followed by endoscopic biopsy. The histologic diagnosis was based on the modified Vienna classification. We investigated the relationship between endoscopic and histologic findings.
RESULS: One hundred eleven of the 203 lesions were classified as Category 1, non-neoplastic lesion (non-NL) and 92 as Category 3/4, neoplastic lesion (NL). In multivariate analysis, compared to non-NL, NL revealed significantly higher incidences of flat or depressed lesions (p=0.001) on CGE and lesions with an irregular pattern of microvessels (p < 0.001) on magnified NBGE. NL consisted of 38 Category 3 lesions and 54 Category 4 lesions. In multivariate analysis, compared to the Category 3 lesions, the Category 4 lesions revealed significantly higher incidence of an irregular pattern of microvessels (p=0.002) on magnified NBGE.
CONCLUSION: Magnified NBGE might be able to complement the diagnostic yield of CGE for NL and to improve that of CGE for Category 4 lesions.

View full abstract

Endoscopic tumor morphology for superficial oropharyngeal and hypopharyngeal cancer has been mentioned in the general rules for clinical studies of head and neck cancer of the Japanese Society for Head and Neck Cancer since the 4th edition in 2005, but its value remains unclear. A total of 172 patients with a total of 262 superficial oropharyngeal and hypopharyngeal cancers were studied retrospectively. There was a significant difference among the endoscopic morphological types both in tumor thickness and the frequency of subepithelial invasion.
When the same lesions were observed respectively by upper gastrointestinal endoscope and laryngoscope, diagnostic disagreement was confirmed in only 4.0% of all cases. In all lesions which were confirmed to show diagnostic disagreement, they were diagnosed as type 0-IIb by laryngoscope whereas they were diagnosed as type 0-IIa by upper gastrointestinal endoscope, whose tumor thickness was comparatively small, and were not accompanied by nodal metastasis.
An accurate diagnosis of type 0-I or 0-IIa lesions is important because of the possibility of nodal metastasis. It is suggested that laryngoscopy is practical for diagnosing tumor morphology.

View full abstract

The formation of fistulas is acknowledged as one of several complications associated with reconstruction surgery with free flap transfer. However, there is no clear consensus as to how to treat the condition once it happens. We reviewed our 321 cases of free flap transfer to evaluate the incidence of fistula formation and whether or not the condition could be treated without additional surgery.
Method: In 5 years (from 2005 to 2009), 321 free flap transfer surgeries were performed in our center. The incidence of fistula formation and medical history of those cases were evaluated.
Result: The most serious complications such as complete failure of the reconstituted flap or rupture of the carotid artery following fistula formation were not reported. Among 34 cases reported for fistula formation, all but one case were treated successfully without additional surgery to close the fistula. A total of 3 cases required more than 6 weeks to close the fistula which included a case in which priority was given to radiation therapy rather than fistula closure, a case with cancer relapse soon after the operation, and a case in which a fistula formed between the pharynx and skin.
Conclusion: With careful observation and appropriate drainage, fistulas can be treated safely without surgical closure. The formation of a fistula itself does not lead to severe complications or delays in starting additional cancer treatment. We suggest non-surgical treatment of fistulas as the primary choice of treatment.

View full abstract

Among 328 patients who underwent free flap reconstruction after excision of head and neck cancer between January 2005 and January 2010, total necrosis of flap occurred in 15 patients. The initial surgeries for primary lesions included total pharyngolaryngoesophagectomy in 7 patients, total maxillectomy in 2 patients, partial maxillectomy in 2 patients, and tumor incision by the pull-through method in 2 patients. The totally necrotized flaps included 7 free jejunum, 3 rectus abdominis musculocutaneous (RAMC) flaps, 2 anterolateral thigh flaps, and 2 fibular bone flaps. For the free jejunum, all the patients were reoperated promptly after free jejunum necrosis was observed. Free flap reconstruction was performed in 10 patients; of 6 patients who received a free flap, the graft survived in 5 patients. In the free jejunum group, there were no differences in length of hospital stay and diet consistency between those receiving free jejunum and those receiving pectoralis major musculocutaneous flap reconstruction, but endoscopic dilatation was necessary in the pectoralis major musculocutaneous flap group. Considering functional and cosmetic aspects, free flap retransplantation is desirable as a salvage strategy for total flap necrosis. When free flap reconstruction is difficult, a pedicled flap may be an option if some degree of function and cosmetic effects can be maintained.

View full abstract

Palliative care for head and neck cancer patients requires an understanding of caring for deformities, conversation difficulties and dysphagia as characteristics of these patients, as well as an understanding of the management of specific symptoms such as bad smell, bleeding and reflex. Even public hospitals can take care of these patients if there is close cooperation with a doctor specialized in head and neck cancer.

View full abstract

Palliative care for patients with head and neck cancer (HNC) is still quite controversial. To explore the role of palliative care for the better overall care of patients with HNC, a panel of specialists discussed the matter at the annual meeting of the Japanese HNC Society. In this article, we discuss the role of otolaryngologists in palliative care.
Otolaryngologists should play an important part in all aspects of the clinical management of these patients. Regarding the choice of treatment, we must inform all treatment modalities including radiotherapy and chemotherapy, while also taking care of their psychological and emotional aspects. It is also crucial to maintain a close relationship between the doctor and HNC patients, even if they are in the terminal stage. For patients with loco-regional recurrence, care of the local site of recurrence is particularly important.

View full abstract

Although evidence should be carefully considered when contemplating treatment for far-advanced or recurrent head and neck cancer, surgery should be indicated for patients with low quality-of-life preoperatively, even if the survival rates are poor. Narrative based medicine is important in such cases, which requires sufficient dialogue with the patient and good human relationships between doctor and patient. The final decision should be made in a multi-disciplinary conference. More surgical evidence on prolonging the at-home period and cost performance is required.

View full abstract

The treatment strategy for locally advanced or recurrent head and neck cancers has been changing dramatically. New technologies in radiation oncology such as intensity modulated radiotherapy (IMRT), and new drugs including molecular targeted agents sometimes offer a chance of cure even in inoperable, far-advanced head and neck cancers. In addition, super-selective intra-arterial infusion of anti-cancer drugs may be one of the treatment options in these settings. IMRT is also used for re-irradiation, which had been thought to be contraindicated, for recurrence after definitive radiotherapy, and has proved to be effective with acceptable adverse reactions. These novel techniques can alter the decision-making in palliative treatment, because they may be able to cure diseases that were thought to be incurable. Here we discuss the present status of these new strategies for locally advanced or recurrent head and neck cancers.

View full abstract

Five patients with far-advanced cancer in the head and neck region underwent chemoradiotherapy using retrograde superselective intra-arterial infusion. Case 1: A patient with lower gum cancer of T4N1M0 underwent superselective intra-arterial chemoradiotherapy (intra-arterial CRT) via the superficial temporal artery and occipital artery, preoperatively. Case 2: A patient with tongue cancer of T4N3M0 underwent intra-arterial CRT for the primary region, and hyperthermia for cervical lymph node metastasis, preoperatively. Case 3: A patient with orbit cancer of T4N0M0 underwent intra-arterial CRT via the superficial temporal artery, preoperatively. Case 4: A patient with tongue cancer of T4N3M0 underwent intra-arterial CRT for the primary region. Intra-arterial chemotherapy via the femoral artery and hyperthermia were additionally performed for cervical lymph node metastasis. Case 5: A patient with recurrence carcinosarcoma of the maxilla underwent intra-arterial CRT and proton therapy. All patients achieved CR in the primary region and cervical region. This therapy is a promising new strategy for far-advanced cancer in the head and neck region.

View full abstract

Recently, many cancer related proteins have been identified for molecular targeted therapy. The expression of EGFR and VEGF has been correlated with prognosis for patients with head and neck squamous cell carcinoma (HNSCC). Anti-EGFR monoclonal antibodies in combination with irradiation have been shown to lead to better patient prognosis. In non-small cell lung cancer, studies have shown that some patients have specific mutations in EGFR that correlate with clinical responsiveness to an EGFR antagonist and molecular analysis enables individualized medical treatment. However, the frequency of EGFR mutations in HNSCC is 32/386 (8.3%) which is clearly lower than in lung cancer.
We review the results of genetic and clinical studies focused on EGFR and VEGF in HNSCC.

View full abstract

Cancer stem cells (CSCs), which have been isolated from some cancer tissues including head and neck cancer, have both the ability to self-renew and to yield differentiated progeny like normal stem cells (NSCs), thereby maintaining themselves and yielding all of the cancer cells at various stages of differentiation. In the microenvironment called a “cancer niche”, CSCs are supposed to be resistant to conventional cancer therapies because of cell cycle quiescence and high drug efflux activity. CSCs are thought to be the origin of recurrence and metastasis. Therefore, molecular targeting therapy to regulate CSCs could enable the prevention of cancer recurrence and metastasis, which would be a milestone in the eradication of cancer.

View full abstract

In the last decade, remarkable studies have revealed that genetic and molecular changes contribute to the development and progression of human cancers. Especially, cytogenetic alteration is the most frequent abnormality in human malignant tumors including head and neck squamous cell carcinomas (HNSCCs). Classical cytogenetic analysis is performed based on chromosomal banding methods, such as G- or Q-banding. In the late 1980s, molecular cytogenetic analysis revolutionized the field of cytogenetics, particularly cancer cytogenetics. Fluorescence in situ hybridization (FISH) to interphase nuclei is useful in cancer cytogenetics, since this method eliminates the need and time for cell culture, and enables the number of genes and chromosomal copies to be determined even in the absence of metaphase chromosomes. Moreover, genome screening approaches such as comparative genomic hybridization (CGH) and spectral karyotyping (SKY) have been used to identify the molecular basis of human malignancies. More recently, microarray technologies combined with these screening methods can be used for rapid and precise investigation. This review presents the status of the clinical application of cytogenetic and FISH analyses, and discusses their problems in clinical applications.

View full abstract

The history and current status of chemoprevention for head and neck cancer are introduced. From epidemiological and biological pre-clinical studies, chemoprevention utilizing retinoid compounds has been studied in depth. The use of 13-cis retinoic acid inhibited the progression of oral premalignant lesions, however, multiple randomized control studies (RCT) showed negative results in preventing second primary cancer. Other compounds such as COX-2 inhibitors and EGCG have also been studied but their efficacy is still not proven in RCTs. Prevention of second primary malignancies is essential for improving the treatment outcome of head and neck cancer. Chemoprevention is an important field of interest for head and neck surgeons.

View full abstract

High-risk human papilloma virus (HPV) types 16 and 18 have been shown to cause cervical cancer as well as other malignant tumors. Recent developments in the field of immunology have resulted in the invention of a vaccine to prevent HPV-associated cervical cancer. Oral HPV infections acquired through oral sex appear to be the principal risk factor for HPV-associated oropharyngeal cancer. Widespread use of the HPV vaccine would reduce the risk of cervical cancer and could decrease the risk of oropharyngeal cancer as well. This article reviews the virus as well as the vaccines and how they could be used for males.

View full abstract

Transoral videolaryngoscopic surgery (TOVS) is one of the laryngeal preservation strategies for supraglottic and hypopharyngeal cancer. This technique is also applicable to oropharyngeal cancer. Surgical procedures are performed bimanually while obtaining a broad working space by a distending laryngoscope and a clear view by a high-definition videolaryngoscope.
The indications for TOVS are T1, T2 and a part of T3 lesions except for tumor invading deep structures or involving more than half of the pharyngeal lumen. Regarding nodal metastasis, concomitant or two-stage neck dissections are performed.
To date, TOVS has been performed in 42 cases of supraglottic and hypopharyngeal cancer (35 cases as initial treatment and 7 cases as salvage surgery). In 35 cases with an observation period of more than 1 year (median: 31 months), 3-year crude survival, disease-specific survival, and laryngeal preservation rates were 83%, 96% and 96%, respectively. TOVS could be an important choice for laryngeal preservation treatment and minimally invasive surgery.

View full abstract

Endoscopic treatment is becoming the standard for superficial cancer of the esophagus, and procedures for endoscopic mucosal resection (EMR) and endoscopic submucosal resection (ESD) have been established. However, endoscopic treatment cannot be the standard therapy for laryngo-pharyngeal superficial cancer, for which radiotherapy is usually the treatment of choice, since the stress of treating the lesion is large. Therefore, since June 2007 we have introduced endoscopic laryngo-pharyngeal surgery (ELPS) in cooperation with a gastrointestinal endoscopist as a minimal invasive surgery for patients with laryngopharyngeal superficial cancer. (Methods) The point of the surgery is to develop the operating field, and identify the lesion and counter-tension during resection. We could make a pharynx one lumen by using a curved laryngoscope, and obtained a sufficient operating field. Furthermore, we were able to identify the range of the lesion part precisely by using Lugol painting, a high-resolution endoscope and NBI endoscope. In cases where resection by the EMR and ESD procedures was difficult, we inserted the laryngeal fiber nasally and were able to make counter-tension during the resection by using retention forceps which we put out from there. Under this counter-tension, we performed resection using a gastrointestinal endoscope (the double scope method). We performed ELPS for 39 lesions up to January 2010, of which 20 lesions underwent resection by the double scope method. (Results) Extensive resection of more than 50 mm was possible. Also, complicated excision to achieve to endolarynx was possible. The pathological results of the resected specimen showed complete resection. (Discussion) Progress in ELPS is expected in future by developing the resection device. The double scope method is thought to be a useful procedure at present.

View full abstract

This study retrospectively reports the midterm results of concurrent superselective arterial chemoradiotherapy for carcinoma of the external auditory canal and middle ear. Fifteen patients (7 males and 8 females) who were treated for carcinoma of the external auditory canal and middle ear between March 2003 and July 2009 were enrolled in this study. The median follow-up period was 14 months (4-44 months). All patients were staged according to the Pittsburgh staging system by Moody as follows: T1 (n=1), T2 (n=1), T3 (n=1), T4 (n=12). Thirteen patients had squamous cell carcinoma, one had adenocarcinoma, and one had undifferentiated carcinoma.
All catheterizations were performed via a transfemoral approach by the Seldinger method. After identifying the feeding arteries of the primary tumor, cisplatin (50 mg/body) was injected. Simultaneously a cisplatin antagonist, sodium thiosulfate, was administered intravenously. Four or five courses of arterial infusion were given weekly. The catheter was removed after each session. External beam irradiation was performed five times a week at 2 Gy per fraction. Total dose ranged from 40 to 60 Gy (median: 60 Gy). The toxicity was evaluated by CTC-AE ver. 3.0.
The 2-year overall survival (OS) rate was 73.4%, and progression free survival (PFS) rate was 53.3% for all patients. Concerning acute toxicity, one patient had Grade 3 dermatitis, and one had Grade 3 leucopenia. No catheter-related complications and no treatment-related deaths were observed. No severe late complications were observed, but one patient had a mild inflammation on the subcutaneous tissue. These results are comparable with those of other reports, suggesting that this method for carcinoma of the external auditory canal and middle ear is acceptable, but the OS rate and PFS rate need improvement. Further investigations are required with larger series to evaluate the long-term survival rate with this treatment.

View full abstract

We reviewed the clinical characteristics of 20 patients with ethmoid sinus carcinoma, 3 patients with frontal sinus carcinoma and 6 patients with sphenoid sinus carcinoma who received treatment at the Kurume University Hospital between 1984 and 2009. Ages of the patients ranged from 35 to 82 years old (average: 62). Six of 10 ethmoid sinus carcinoma patients who were treated by combined treatment with surgery were alive. Two of 10 ethmoid sinus carcinoma patients without surgery were alive. All patients with frontal sinus carcinoma who received combined treatment with anterior skull base surgery were alive with local control. Patients with sphenoid sinus carcinoma were treated by chemoradiotherapy and 4 patients were alive. The results of this clinical study indicate that combined therapy including skull base surgery is effective for ethmoid sinus and frontal sinus carcinomas. In contrast, chemoradiotherapy is favorable for sphenoid sinus carcinomas.

View full abstract

Thirty patients (19 males, 11 females) with advanced maxillary squamous cell carcinoma received superselective intra-arterial Cisplatin infusion chemotherapy combined with radiotherapy and surgery for maxillary squamous cell carcinoma.
The five-year overall survival rate and cause-specific rate were 83.1% and 89.6% for all patients, respectively. Regarding clinical T stage, the five-year cause-specific survival rate was 100% in T3 and 84.7% in T4.
As for the preservation of organ function, all 30 patients retained orbital contents and 26 patients retained hard plate after initial treatment. Regarding delayed complications of these series of treatments, loss of ocular function occurred in two patients and deformity of the cheek occurred in 5 patients.
These results suggested the clinical efficacy of superselective intra-arterial Cisplatin infusion chemotherapy combined with radiotherapy and surgery, but the occurrence of delayed complications must be considered.

View full abstract

The lingual lymph nodes are intercalated nodes situated in the sublingual space and were divided into the lateral group and the median group by Rouvière in 1938. At our institute, between 1991 and 2008, lingual lymph nodes metastases (LLNM) or tumor emboli of the lingual lymphatic vessel were suspected on CT in seven patients with squamous cell carcinoma of the tongue. However, five of them died from the disease. We analyzed our own cases and 32 other cases reported in Japanese articles, focusing on the clinical characteristics and CT or MRI findings. The primary sites were the tongue in 34 cases and the floor of the mouth in five. In thirty-four cases (87%), cervical lymph node metastases developed, and in five (13%), LLNM were not associated with neck node metastases. In 26 patients (76%), neck node metastases were found simultaneously with LLNM. The two-year survival rate was less than 50%. In our own cases, as CT findings, rim enhancement and internal low density area were very useful in the imaging diagnosis of LLNM. LLNM developed frequently in six months postoperatively, thus, carcinoma of the tongue and the floor of the mouth should be considered for LLNM, although uncommon, even in the early follow-up period.

View full abstract

We analyzed the presence of HPV from 53 patients diagnosed with oropharyngeal squamous cell carcinoma. In total 14/53 (26%) were HPV-positive. In 14 HPV-positive patients, 12 patients (86%) were HPV-16-positive, 1 patient was HPV-18-positive, and 1 patient was HPV-58-positive. HPV-positive patients had significantly better disease-specific survival rates than HPV-negative patients. Compared with patients with HPV-negative tumors, patients with HPV-positive tumors had higher response rates after chemoradiation treatment. For patients with HNSCC of the oropharynx, tumor HPV status is strongly associated with chemoradiation response and survival.

View full abstract

Object: To clarify the characteristics of treatment for elderly head and neck squamous cell cancer patients.
Material and Methods: We conducted a chart review of 177 head and neck squamous cell cancer patients who had been treated at Kyoto Medical Center, from 2005 through 2009. All the collected data were analyzed to compare the clinical features and the treatment outcomes between the younger group (< 75 years of age, YG, n = 131) and the elderly group (> or = 75, EG, n = 46).
Results: Male to female ratio was lower in EG (5.6 : 1 vs. 1.7 : 1, p < 0.01). C urative treatment was performed in most of the patients with early disease (stage I-II) in both groups (96.7% vs. 90.5%), while the ratio of curative treatment was significantly lower in EG patients with advanced stage disease (stage III-IV) (92.3% vs. 52.0%, p < 0.01). There was no significant difference in the frequency of adopted treatment modality (surgery or radiotherapy) between YG and EG. Adjuvant chemotherapy or postoperative radiotherapy was avoided in most of EG patients. Local complication rates after major surgery for advanced cases were similar in both groups (30.8% vs. 27.3%), while a higher systemic complication rate was observed in EG (0% vs. 27.3%). After curative treatment, there was no difference in disease specific three-year survival rates between YG and EG (100% vs. 100% in early stage disease, 65.2% vs. 60.6% in advanced disease, Kaplan-Meier curve).
Conclusion: Although treatment of elderly patients with head and neck cancer can be inhibited by poor performance status and/ or concomitant diseases, clinical results after curative treatment are comparable to those of younger patients.

View full abstract