Salivary gland cancers in elderly patients: challenges and therapeutic strategies

Abstract

Salivary gland carcinomas (SGCs) are the most heterogeneous subgroup of head and neck malignant tumors, accounting for more than 20 subtypes. The median age of SGC diagnosis is expected to rise in the following decades, leading to crucial clinical challenges in geriatric oncology. Elderly patients, in comparison with patients aged below 65 years, are generally considered less amenable to receiving state-of-the-art curative treatments for localized disease, such as surgery and radiation/particle therapy. In the advanced setting, chemotherapy regimens are often dampened by the consideration of cardiovascular and renal comorbidities. Nevertheless, the elderly population encompasses a broad spectrum of functionalities. In the last decades, some screening tools (e.g. the G8 questionnaire) have been developed to identify those subjects who should receive a multidimensional geriatric assessment, to answer the question about the feasibility of complex treatments. In the present article, we discuss the most frequent SGC histologies diagnosed in the elderly population and the relative 5-years survival outcomes based on the most recent data from the Surveillance, Epidemiology, and End Results (SEER) Program. Moreover, we review the therapeutic strategies currently available for locoregionally advanced and metastatic disease, taking into account the recent advances in precision oncology. The synergy between the Multidisciplinary Tumor Board and the Geriatrician aims to shape the most appropriate treatment pathway for each elderly patient, focusing on global functionality instead of the sole chronological age.

Predictors of recurrence and disease-free survival for salivary gland tumors among children and young adults in Kampala, Uganda: a retrospective follow-up study

“…There are numerous both mono-and poly-chemotherapy that are used as a palliative treatment for patients with SGTs that do not benefit from local treatment modalities such as surgery or radiation [49]. However, Due to lack of congruent evidence-based data, the decision of using either adjuvant chemotherapy in the treatment of malignant SGTs or as a palliative agent must be on case by case so as to prevent possible related complications [50].…”

Descriptive epidemiology of the head and neck cancers in old patients

“…Curative treatment will be more effective and completely achievable in localized diseases. The epithelial tumors of major salivary glands and salivary-gland type tumors, also described in the paper by Colombo et al of this special issue(19), stated that good prognosis histotypes and early-stage diagnosis is less common in the elderly with respect to the younger patients. Furthermore, unspecified histotypes presented more frequently in the elderly.…”

Current management and future challenges in salivary glands cancer

“…In 2020, 43% of SGCs occurred in the elderly, causing 12,339 cancer-specific deaths, with a male-to-female ratio of 1.3:1. In the next two decades, the new diagnoses in the elderly age group are expected to account for 80% of the total SGCs diagnoses ( 3 ). The review of the Surveillance, Epidemiology and End Results (SEER) Program database indicated that the incidence of major salivary glands and salivary gland-type cancers in patients over 65 years was 4 and 7 times higher, respectively, than that reported in younger patients and the overall 5-year survival rates were significantly better in young than in elderly subjects who, more frequently, presented histotypes with poor prognosis (e.g.…”

“…salivary duct cancer) or unspecified histotypes ( 3 ). Indeed, almost half of SGCs cases from the SEER dataset presented at diagnosis with localized disease, without significant differences between major salivary glands and salivary gland-type carcinomas, while elderly patients were diagnosed more frequently at a metastatic stage ( 3 ).…”

“…The review of the Surveillance, Epidemiology and End Results (SEER) Program database indicated that the incidence of major salivary glands and salivary gland-type cancers in patients over 65 years was 4 and 7 times higher, respectively, than that reported in younger patients and the overall 5-year survival rates were significantly better in young than in elderly subjects who, more frequently, presented histotypes with poor prognosis (e.g. salivary duct cancer) or unspecified histotypes (3). Indeed, almost half of SGCs cases from the SEER dataset presented at diagnosis with localized disease, without significant differences between major salivary glands and salivary gland-type carcinomas, while elderly patients were diagnosed more frequently at a metastatic stage (3).…”