Treatment of Elderly Patients with Head and Neck Cancer.

In our aging society, the proportion of cancer cases in the elderly (65 years) is steadily rising. In the developed countries, the majority of head and neck squamous cell cancer affect senior people. Despite that, elderly-specific prospective trials are lacking, and these patients represent a particularly challenging population to manage. They often have decreased physiologic reserves and suffer from chronic diseases. In addition to fluctuations in social support and economic resources, older age is also associated with enhanced susceptibility to stress and altered pharmacokinetics and pharmacodynamics. Consequently, owing to concerns about excessive toxicity and insufficient efficacy, multimodality treatment is frequently withheld in these patients compared with their younger counterparts. However, chronological age is not a reliable predictor of life expectancy or the risk of adverse events. It has repeatedly been shown that fit elderly individuals may, indeed, benefit from intensive therapies like reconstructive surgery with microvascular free tissue transfer, concurrent chemoradiotherapy in locoregionally advanced setting, and even from the standard first- and second-line palliative systemic therapies, being the PFE regimen (platinum/5-fluorouracil/cetuximab) and immune oncology drugs, respectively. In this respect, geriatric assessment tools have been developed to differentiate between fit and frail senior persons and guide treatment decisions. A comprehensive geriatric assessment (CGA), evaluating functional status, comorbidities, and some other parameters, requires skilled professionals, is time-consuming and not necessary in every case. Thus, geriatric screening tools (e.g. G8 and Flemish version of the Triage Risk Screening Tool) have been introduced to clinical practice enabling to decide who will need a full evaluation (CGA), who will benefit from a specific examination, and who needs no further testing. With the advent of immune checkpoint inhibitors, new questions have emerged as to whether immunotherapy is feasible and effective in the elderly. These issues including the changing portfolio of anti-cancer agents and integration of clinical practice-oriented assessment tools should be, therefore, further explored