Background In the treatment of head and neck squamous cell carcinoma (HNSCC), the survival rate of patients with HNSCC can be significantly improved by using simultaneous chemoraotherapy or simultaneous molecular targeting of EGFR. But older patients may receive less aggressive and suboptimal treatment than younger patients with the same disease status. The treatment choice of elderly patients with advanced head and neck squamous cell carcinoma is a difficult problem faced by current clinical treatment.

Objective To investigate the efficacy and safety of comprehensive treatments in elderly patients with head and neck squamous cell carcinoma (HNSCC).

Methods Clinical data about patients who were admitted to the Department of Otolaryngology, Head and Neck Surgery, the First Medical Center of Chinese PLA General Hospital from February 2012 to June 2021, were analyzed retrospectively. The overall survival (OS) and progression-free survival (PFS) were determined by Kaplan-Merier method, and log-rank test was adopted to compare the differences between subgroups. Adverse events were evaluated with the established common terminology criteria for adverse events (CTCAE) version 5.0 criteria.

Results Totally 36 patients were included. The median age was (78.0 ± 3.0) years old (ranged from 75 to 87 years old), and their mainly clinical stage was Ⅲ - Ⅳ. All the patients received induction chemotherapy +/- EGFR molecular targeted therapy followed by concurrent radiotherapy combined with EGFR molecular targeted therapy +/- chemotherapy. Among them, 24 patients received EGFR molecular targeted therapy at the ICT stage, 21 patients received chemotherapeutic drugs at concurrent radiotherapy combined with EGFR molecular targeted therapy, and 15 patients received radiotherapy combined with EGFR molecular targeted therapy. Intensity modulated radiotherapy was used for radiotherapy, the total dose of radiotherapy was 66 - 70 Gy. All patients completed the established chemotherapy and EGFR molecular targeted therapy schedule, and 35 patients (97.2%) completed the established radiotherapy schedule. After 1 month of comprehensive treatment, imaging results showed that all patients achieved complete remission. The OS rate was 84.8% at 1 year, 49.2% at 2 years, 41.0% at 3 years, and the PFS rate was 85.8% at 1 year, 46.1% at 2 years, and 34.1% at 3 years; The median survival time was 20 months. Univariate analysis showed that the survival time of concurrent chemoradiotherapy + EGFR molecular targeting group was longer than that of radiotherapy + EGFR molecular targeting group alone (13 months vs 36 months). The 2-year OS rate and PFS rate in the radiotherapy alone plus EGFR molecular targeting therapy group was 38.8% and 11.8%, lower than 67.1% and 67.1% in the concurrent chemoradiotherapy plus EGFR molecular targeting therapy group, and the differences in OS and PFS were statistically significant (all P<0.05). In the course of comprehensive treatment, there was no aggravation of the chronic disease caused by radiotherapy and chemotherapy, and no death caused by drug-related side-effects. The common hematological side-effects were myelosuppression, of which 4 patients had grade 4 leukopenia, 1 patient had grade 4 thrombocytopenia, 9 patients had grade 3 leukopenia, 3 patients had grade 3 thrombocytopenia, and 1 patient had grade 3 erythrocytopenia. The common non-hematological side-effects were radiation oropharyngeal mucositis, 5 patients had grade 3 radiation oropharyngeal mucositis.

Conclusion Comprehensive treatment for elderly patients with squamous cell carcinoma of head and neck has definite curative effect and better survival rate, and side-effects of treatment can be tolerated, which is a safe and effective treatment choice for advanced elderly patients with head and neck malignant tumors.