TREATMENT OF LARYNGEAL AND HYPOPHARYNGEAL CANCER IN THE ELDERLY FROM THE AGE OF EIGHTY
Raphael Fernandes Calhau* MD, Terence Farias MD, MsC, PhD, Researcher, Adeilson Moreira Júnior MD, Emílio Tosto Neto MD and Fernando Luiz Dias MD, MsC, PhD, FACS
Introduction: Characteristics of the Brazilian population have been changing in the recent decades. A growth of the senior population since the eighties has resulted in alteration in the incidence of the diseases and mortality. Objective: to study the epidemiological and prognostic factors and predictive responses of squamous cell carcinoma of larynx or hypopharynx treated in patients with 80 years or older. Methods: a retrospective study analyzed the medical records of 38 patients with 80 years or older treated for larynx or hypopharynx cancer at the National Institute of Cancer, Rio de Janeiro, (INCA/MS) between January 2015 and December 2018. Gender, age, stage, treatment carried out and the patients' clinical evolution were analyzed. For the statistical analysis, the p value was considered significant when smaller than 0.05, when calculated by the qui-square method and the regression of Cox. The survival curves were analyzed by the Kaplan-Meyer method. Results: twenty-seven elderly patients with larynx cancer and 11 with hypopharynx cancer were included, being 26 (68.4%) men and 12 (31,6%) women. The mean age was 84.8 years (80 to 94 years). Seventy-nine percent of patients had stages III or IV of disease. Eighteen patients (47.4%) were treated, 6 (15.8%) underwent surgery at some point of the treatment. Twelve patients (44.4%) were treated by exclusive radiation therapy, with an average dose of 51.4 Gy (6â€“70 Gy). Complete response of treatment was achieved in 13 cases (48.1%), eight of them treated solely by radiation therapy, 3 by surgery alone and 2 by surgery combined with radiotherapy. The incidence of recurrence was 26.3% (10 cases) and death occurred in 24 cases (63.1%). The mean disease-free survival was 11 months, and mean overall survival was 10.3 months. The most important prognostic factors to increase mortality were the tumor size (p = 0.04) and stage of disease (p = 0.03). No difference in survival was noted comparing treatment modalities (p = 0.53). Conclusion: the most important prognostic factors to increase mortality were tumor size (p = 0.04) and stage of disease (p = 0.03). There was no variable evidence of prognostic impact in recurrence of the disease. Treatment modality in this group of patients showed no difference in disease-free survival and overall survival.
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