%0 Journal Article
%T Management of Early Head and Neck Cancer in Elderly Patients
%A Adam S. Howard
%A Daniel J. Haraf
%A Everett E. Vokes
%A Michael J. Jelinek
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.18.00078
%X INTRODUCTION Section: ChooseTop of pageAbstractINTRODUCTION <<ORAL CAVITYOROPHARYNXHYPOPHARYNXLARYNXNASOPHARYNXGERIATRIC ASSESSMENTREFERENCES Head and neck squamous cell cancer (HNSCC) is an aggressive epithelial malignancy of the upper aerodigestive tract. Patients age 65 years and older account for nearly half of the newly diagnosed cases of HNSCC annually.1 Because of the potential frailty of the elderly, it is imperative to understand the appropriate treatment of HNSCC in this population. This review aims to familiarize physicians with management options for early (stage I and II) HNSCC in patients older than 65 years. HNSCC can be divided into human papillomavirus (HPV)¨Crelated and non¨CHPV-related disease; recognition is growing about the role HPV plays in the pathogenesis of HNSCC. HPV-related HNSCC primarily develops in the oropharynx and, much more rarely, in the oral cavity.2 The main risk factor for HPV-related disease is sexual activity that leads to HPV exposure. From 2002 to 2012, the incidence of HPV-related oropharyngeal carcinoma increased by 2.5% annually. Although younger patients are affected more frequently by HPV-related HNSCC, patients older than age 60 years experienced a 3.17% annual increase in HPV disease.3 It is important to identify HPV-related HNSCC in all patients, because it confers improved overall and progression-free survivals.4 Non¨CHPV-related HNSCC is generally associated with lower cure rates and can develop anywhere throughout the upper aerodigestive tract. The main risk factors are tobacco and alcohol use, which have a synergistic carcinogenic effect when used in combination. The incidence of non-HPV HNSCC is decreasing in the United States, likely because of decreased tobacco and alcohol use.3 Symptoms of HNSCC, such as referred otalgia, dysphagia, and globus sensation, can overlap for the site of origin. However, some sites can present specific symptoms, such as dysphonia or hoarseness in laryngeal cancer, or a palpable mass or poorly fitting dentures in oral cavity tumors. The majority of patients with HNSCC will present without distant metastases and should be treated with curative intent, especially in early-stage disease. Management of HNSCC includes at least one of three modalities: surgery, radiotherapy, and systemic therapy. The role of each modality varies with primary tumor location, stage, and treatment intent. The main sites of HNSCC include the oral cavity, oropharynx, hypopharynx, larynx, and nasopharynx. Early HNSCC is generally treated by single-modality therapy (either surgery or radiotherapy
%U http://ascopubs.org/doi/full/10.1200/JOP.18.00078