Non-surgical definitive treatment and geriatric assessment in older patients with locally advanced head and neck cancer

Population aging is rapidly progressing worldwide, and Japan has the most advanced aging population. Consistent with this trend, the proportion of older patients with head and neck cancer has markedly increased. Non-surgical definitive treatment for locally advanced head and neck cancer consists of radiotherapy (RT) alone or RT combined with systemic therapy; however, optimal treatment selection in older patients remains challenging due to their increased vulnerability to treatment-related toxicities and the limited availability of age-specific evidence. This review summarizes current evidence on non-surgical treatment strategies and the role of geriatric assessment (GA) in older patients with locally advanced oropharyngeal, hypopharyngeal, and laryngeal cancers. Although concurrent chemoradiotherapy (CRT) with high-dose cisplatin remains the standard of care for fit patients, its survival benefit appears attenuated in patients aged 70 years or older. Alternative approaches, including weekly cisplatin-based CRT, RT with other systemic agents, or RT alone, are frequently considered; however, the strength of supporting evidence varies. International guidelines recommend that treatment decisions for older adults be based on overall health status rather than chronological age alone. GA provides a structured framework to evaluate vulnerability across multiple domains, but remains underutilized in routine practice. Individualized, GA-guided treatment strategies with multidisciplinary discussion are essential for optimizing outcomes in this growing patient population.