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Clinical Challenges in Otolaryngology
December 1999

Treatment of Stage III and Stage IV Supraglottic CarcinomaShould Elderly Patients Undergo Standard Treatment Protocols?

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Arch Otolaryngol Head Neck Surg. 1999;125(12):1406-1407. doi:10.1001/archotol.125.12.1406

In their articles, Drs Bumpous and Fee favorably uphold the premise that the treatment of a T3, N1, M0 supraglottic carcinoma should be the same in an otherwise healthy 80-year-old patient as in an otherwise healthy 40-year-old patient. They base much of their arguments on actuarial data and other objective clinical measurements. They reference several articles that demonstrate that elderly patients can physically handle rigorous treatment protocols. Actuarial data indicating that an 80-year-old person has a life expectancy measured in years, rather than weeks or months, are the impetus to adopt an interventional approach to the treatment of advanced head and neck cancer in the elderly. Unfortunately, the relevant question is not, "What is the life expectancy of an otherwise healthy 80-year-old person?" Nor is it, "Can this population handle standard therapy?" Rather, it is, "What is the life expectancy of an 80-year-old person with stage III or stage IV disease?" The answer to the latter question is not readily available; however, data from the EUROCARE II project,1 a 20-year prospective collection of data on patients with cancer, give a much more realistic and plausible answer. In that large study, patients with laryngeal carcinoma, including glottic, supraglottic, and hypopharyngeal primary tumors, had an overall survival rate of 63%. When data were stratified by age, the elderly (defined as older than 65 years) were found to have a significantly diminished life expectancy. The National Cancer Data Base Report on cancer of the head and neck did not stratify 5-year survival rates based on age2; it is hoped that these data will be forthcoming as they are subjected to more detailed analysis.

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