This systematic review evaluated systemic treatment options — chemotherapy, targeted therapy, and immune checkpoint inhibitors (ICIs) — in patients aged 65+ with HNSCC receiving definitive or adjuvant radiotherapy, drawing from 35 included studies.
Cisplatin-based CRT was the most effective and tolerable option for fit elderly patients. In unfit patients, cetuximab and carboplatin showed variable results. Adding ICIs to radiotherapy appeared feasible and safe, but efficacy data and predictive biomarkers remain insufficient.
- Elderly patients are underrepresented in trials, limiting the evidence base. - Study heterogeneity across the 35 included studies makes direct comparisons difficult. - Evidence in the adjuvant setting is especially sparse.
Use a comprehensive geriatric assessment — not age alone — to guide systemic therapy decisions in older HNSCC patients. Fit elderly patients can receive cisplatin-based CRT, but treatment should be individualized given the heterogeneity of available data.
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