The rate of cancer in elderly patients is rapidly increasing in Japan. Treatment possibilities for these patients are very limited because of complications. Brachytherapy, a type of radiation therapy, is a treatment option for these patients. In this study we describe our use of brachytherapy to treat oral and oropharyngeal cancers in the very elderly, as well as factors that influence patient survival.
We reviewed brachytherapy results for patients over age 80 who had been diagnosed with primary oral and oropharyngeal cancers (all of which were squamous cell carcinoma). Between 2000 and 2010, we treated 108 of these patients with brachytherapy (n = 56, men; n = 52, women; median age, 83; range, 80–93 years). Locations for these cancers included the tongue (n = 57), buccal mucosa (n = 19), and oropharynx (n = 10). All patients were treated with low-dose-rate brachytherapy i.e., 198Au seeds, (n = 94); 137Cs needles, (n = 3); and 192Ir pins, (n = 11).
All 108 patients completed treatment. Median disease-specific survival (DSS) rate was 63.6%. Overall survival (OS) rate was 49.8%. A total of 11 patients died from other diseases during follow-up. The result also revealed subsequent recurrences (neck lymph node metastases) in 40 patients. Understandably, the DSS rate in patients with no neck metastases was significantly higher than in patients with neck metastases. Of the 40 patients, only 12 had surgical treatment and 16 were treated with external beam radiation therapy (EBRT) alone. The DSS rate of patients treated with surgery was significantly better than that of patients treated with EBRT alone.
Brachytherapy for oral and oropharyngeal cancers is feasible for the very elderly, with treatment results that compare favorably with those of younger patients. However, if primary cancerous lesions are successfully treated with brachytherapy, patient survival appears to depend mainly on regional recurrence (most often, neck lymph node metastases). Elderly patients who undergo surgery for neck metastases can expect outcome to be similar to that of younger patients.
Clinical trial identification
All authors have declared no conflicts of interest.