Chirurgie von Karzinomen der oberen Luft- und Speisewege bei Patienten im fortgeschrittenen Lebensalter

Zusammenfassung

Hintergrund: Zur Therapie und Prognose fortgeschrittener Karzinome des oberen Aerodigestivtraktes bei Patienten im hohen Lebensalter existieren nur wenige valide Untersuchungen. Bei diesen Patienten wird nicht selten bereits aufgrund des Alters eine unvollständige Diagnostik und Therapie durchgeführt, ohne dass diese Einschränkung tatsächlich kritisch hinterfragt wird.

Methode: Der bisherige Kenntnisstand zur Problematik der Therapie älterer Patienten mit Karzinomen der oberen Luft- und Speisewege wird in einer Literaturrecherche hinterfragt. Die erhobenen Ergebnisse dienen als mögliche Entscheidungshilfe für eine individuell auszurichtende Strategie.

Ergebnisse: Ein Vergleich der Literaturdaten verdeutlicht, dass das hohe Lebensalter als eigenständige Variable sicher keine Kontraindikation für eine adäquate Therapie darstellen darf. Auch für alte Patienten mit einem fortgeschrittenen Karzinom kann eine aggressive Therapie mit kurativer Intention in Betracht kommen. Sichere Nachweise einer signifikanten Erhöhung der Mortalität und Komplikationen ließen sich für die Gruppe älterer Patienten bisher nicht erbringen.

Schlussfolgerungen: Die Behandlungsplanung von Patienten mit Karzinomen der oberen Luft- und Speisewege sollte das Alter als einen, keineswegs aber als den zentralen Faktor einbeziehen.

Abstract

Background: The literature on management of advanced head and neck cancer in the elderly is limited. Diagnostic and treatment decisions may be implicated by advanced age itself.

Method: Treatment outcomes of head and neck cancer in elderly patients were reviewed in the literature. The results should serve as a basis for an individualized treatment strategy.

Results: A comparison of data shows that chronologic age alone should not be a contraindication to adequate oncologic surgery. An aggressive approach to head and neck cancer management with curative intention can be also considered in high aged patients with advanced cancer. Surgical therapy of head and neck cancer can be as effective in elderly patients as in younger patients without a significant increase in mortality and complications.

Conclusions: Head and neck cancer patients of all age groups should have a treatment of equal quality regardless of whether the expected outcome is cure or palliation.

Schlüsselwörter

Fortgeschrittenes Lebensalter - Therapie - Prognose - Kopf-Hals-Karzinome

Key words

Age - Elderly - Therapy - Prognosis - Head and neck cancer

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