LA GESTIONE DEL CARCINOMA DEL CAVO ORALE NELL'ANZIANO
D. Galanti, E. Bronte, L. Terruso, G. Rinaldi
Vol.2 (2017), issue 4, pag.8-13
| Received | 14/09/2017 |
| Accepted for pubblication | 19/10/2017 |
| Published | Dec. 2017 |
| Review by | Single-blind |
ABSTRACT
Incidence of oral cancer is rapidly increasing especially in elderly patients that are often excluded from clinical trials because of their comorbidities or Performance Status. We want to explore how to manage elderly patients with oral cancer to obtain a favourable outcome and ensure a good quality of life. Before treating elders affected by oral cancer, it is recommended to do a multidimensional evaluation which takes into account not only age, but also life-expectancy, comorbidities, functional, nutritional and neuropsychological status and social support. The best geriatric screening test is Comprehensive Geriatric Assessment (CGA), but it is very time-consuming so we can use other geriatric screening tests to detect who have to undergone to CGA. Surgery is a suitable option only for selected patients, because perioperative morbility is higher in elderly. Radiotherapy is shown to be equivalent in younger and older patients in overall survival, locoregional control and safety. Only mucosites were more common
in elderly, although this age dependency disappeared after adjustment for performance status. Therefore, radiotherapy is an important option when surgery is dangerous or contraindicated. Chemoradiotherapy is shown not to be able to obtain the same outcome in elderly, causing more not-cancer-related death inflicted by chemotherapy. Higher incidence of platinum-related toxicities was detected. About medical therapies, the addition of cetuximab to platinum-5FU doublet in EXTREME trial and platinum chemotherapic doublets aren’t shown to be able to improve overall survival in elderly, causing increased toxicity. In the
selection of chemotherapic drugs we have to focus renal and epatic impairments, polypharmacy, comorbidities and give adequate hydration, nutrition, even with feeding tubes, and supportive care for pain, mucosites, nausea, vomiting and other toxic effects. Treatment of oral cancer in elderly depends on a multidimensional evaluation of patients and have to aim to give them a good quality of life, without under-treatment