With regard to causes of death by age, there was no difference in incident cancers or second primary tumors, signaling that this shorter survival in older adults was due to other causes (34.8 versus 19.5% in younger counterparts) (76). So, does this mean that elderly patients should not be treated with concurrent chemoradiotherapy, which may even decrease survival and elicit significantly more acute and late toxicity? Adding further to the controversy, two large studies of population-based cross-sectional registries provided an alternative view on this matter. Due to physiological changes in drug metabolism occurring with advancing CB 300919 age, the major concerns relate to chemotherapy administration. In locally advanced SCCHN, concurrent chemoradiotherapy in patients over 70?years remains a point of controversy owing to its possibly higher toxicity and questionable benefit. However, accumulating evidence suggests that it should, indeed, be considered in selected cases when biological age is taken into account. Results from a randomized trial conducted in lung malignancy showed that treatment selection based on a comprehensive geriatric assessment (CGA) significantly reduced toxicity. However, a CGA is usually time-consuming and not necessary for all patients. To overcome this hurdle, geriatric screening tools have been introduced to decide who requires such a full evaluation. Among the various screening instruments, G8 and Flemish version of the Triage Risk Screening Tool were prospectively verified and found to have prognostic value. We, therefore, conclude that also in SCCHN, the application of elderly specific prospective trials and integration of clinical practice-oriented assessment tools and predictive models should be promoted. strong class=”kwd-title” Keywords: head and neck malignancy, comprehensive geriatric assessment, screening tools, medical procedures, radiotherapy, chemotherapy, targeted therapy, immunotherapy Introduction Head and neck malignancy refers to a heterogeneous group of malignancies originating from the upper aero-digestive tract, including the oral cavity and lip, the pharynx, the larynx, the salivary glands, the ear, the nasal cavity, and the paranasal sinuses (1, 2). More than 90% of the head and neck cancers are of squamous cell origin and are CB 300919 classified as squamous cell carcinomas of the head and neck (SCCHNs). In 2012, it was estimated that SCCHN of the lip, oral cavity, pharynx, and larynx accounted for a total of 686,300 new cases and 375,700 malignancy deaths worldwide, thus representing the seventh most common neoplasm in terms of incidence and mortality (3). Forty percent of patients present with early disease (stages I and II). In this setting, cure rates around 80% have been achieved with single-modality treatments, either surgery or radiotherapy. CB 300919 The remaining 60% of cases are diagnosed with advanced stages encompassing locally advanced (stages III and IVA/B) and metastatic CB 300919 tumors (stage IVC). Despite a multimodality approach, the majority of patients with locally advanced SCCHN develop recurrences or distant metastases, so that 5-12 months overall survival does not usually exceed 60% (4). The presence of distant metastases or recurrent disease unsuitable for surgery or radiotherapy portends a poor prognosis with an expected survival in the order of 6C10?months (5). In 1971, Abdel Omran coined the term epidemiological transition to explain hSPRY1 the changes in population with respect to mortality and disease patterns. According to this theory, all societies experience a shift from infectious (cholera and tuberculosis) to chronic and degenerative diseases (cardiovascular and neoplastic), which is usually paralleled by increasing life expectancy (6). Analogously, malignancy transition refers to a shift from infection-related cancers to cases associated with reproductive, dietary, and hormonal factors (7). The first concept displays the evolving demographic scenery of head and neck malignancy, since the global malignancy burden, including SCCHN, is usually rising with the predilection of the elderly population. However, the second point concerning the malignancy transition should be interpreted with caution. Although the major risk factors for head and neck carcinogenesis pertain to behavioral patterns [i.e., tobacco abuse, alcohol consumption, and human papillomavirus (HPV) contamination] and are, therefore, preventable, they still pose a serious challenge for public health policy (8). In this regard, driven by the tobacco epidemics, oral cancer incidence rates declined among men and women in countries with effective CB 300919 prevention strategies.