Evaluation And Management Of Complications
高齢者頭頸部癌症例における背景因子の特徴や治療法の選択,治療による合併症などについて非高齢者群と比較対比して検討した.検討対象は70歳以上の頭頸部癌一次症例121例である.70歳〜79歳を高齢者群,80歳以上を超高齢者群に分類した.また比較対象群として50歳代の群(56例)についても検討した.原発部位は舌 口腔および喉頭癌がともに28%と最も多かった.併存全身疾患保有率は高齢者群74%,超高齢者群93%で,非高齢者群に比べ有意に高かった.内訳として高血圧,虚血性心疾患,呼吸障害,腎機能低下などが多かった.治療は放射線治療と外科的治療が中心であった.周術期合併症の発生率は非高齢者群の56%に対し,高齢者•超高齢者群では48%であった.
麻痺のケーススタディ高齢者超高齢者群では特に心血管系合併症,誤嚥性肺炎,術後譫妄,腎障害が多かった.放射線治療における合併症発生率は非高齢者群14%,高齢者群27%であったが,超高齢者群では53%と高頻度で,粘膜障害による摂食不良,肺炎,脱水電解質異常が高率に見られた.高齢者 超高齢者群においても根治治療が原則となるが,治療にあたっては個々の身体的•社会的活動性,治療意欲,臓器予備能力を正確に評価することが大切である.また,集学的治療を選択する機会の多い非高齢者群に比べ,より治療効果と全身状態への影響のバランスを考慮した治療法の選択が重要である.
メリーランド大学の頭痛センター
With the population over age 70 growing, treatment for head and neck cancer in the elderly has increased. We retrospectively evaluated their management and outcome.Subjects numbered 121-83 men and 38 women from 70 to 94 years old-initially treated at our hospital. We classified them into 2 groups by age-the aged at 70-79 years (55 men and 26 women) and the very old at 80 years and older (28 men and 12 women), We also evaluated a younger control group aged 50-59 years (37 men and 19 women).Primary tumor sites were the oral cavity (28.1%), larynx (28.1%), paranasal sinus (15.8%), and hypopharynx (9.9%). Preoperative geriatric disease was seen in 54% of controls. 74% of the aged. and 93% of the very old. Cardiovascular and respiratory diseases were most common. Surgical treatment and irradiation were essential for cancer treatment. Postoperative complications, including pneumonia, delirium, renal and cardiovascular hypofunction occurred in 56.
ハーバライフの減量は、それが動作しない5% of controls, 18.2% of the aged, and 17.8% of the very old. The frequency of postoperative complications correlated significantly with the American Society of Antsthesiologist classification of physical status (ASA) and preoperative performance status (PS). The complications of irradiation including pneumonia, dehydration, and feeding disturbance occurred in 53% of the very old.Cures were achieved in 83.9%, of controls, 81.5% of the aged, and 65.0% of the very old. Cause specific 5-year survival in those cured was 85.2% of controls, 84.5% of the aged, and 80.0% of the very old. Median survival in those not cured was 4 months in control, 9.6 months in the aged, and 5 months in the very old.We concluded that Curative treatment is important in the elderly, and the success of curative treatment and the prevention of complications depend on careful assessment of systemic disease, PS, ASA, and mental activity.
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