title: Craniofacial resection for malignant tumors involving the skull base in the elderly: an international collaborative study.
abstract: BACKGROUND
  In this study by the International Collaborative Group, the authors examined a large cohort of patients accumulated from multiple institutions that had experience in craniofacial surgery with the objective of reporting outcomes and complications for craniofacial resection (CFR) in the elderly.
  
  
  METHODS
  One hundred seventy patients aged ≥70 years were included in the study. The median age was 75 years (range, 70-98 years). One hundred four patients (61%) had received previous single-modality or combined treatment, which included surgery in 79 patients (46%), radiation in 47 patients (28%), and chemotherapy in 13 patients (8%). The most common histology was squamous cell carcinoma (67 patients; 39%). The margins of resection were close or microscopically positive in 56 patients (33%). Sixty-eight patients received adjuvant radiotherapy (40%), and 3 patients received chemotherapy (2%). Complications were classified into overall, local, central nervous system (CNS), systemic, and orbital. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were determined by using the Kaplan-Meier method. Outcomes were compared with patients aged <70 years. Statistical analyses for outcomes were performed in relation to patient characteristics, tumor characteristics (including histology and extent of disease), surgical resection margins, previous radiation, and previous chemotherapy to determine predictive factors.
  
  
  RESULTS
  Postoperative mortality occurred in 16 patients (9%), and postoperative complications occurred in 72 patients (42%). Local wound complications occurred in 40 patients (24%), CNS complications occurred in 24 patients (14%), systemic complications occurred in 19 patients (11%), and orbital complications occurred in 4 patients (2%). Postoperative mortality and complications were significantly more frequent in elderly patients compared with patients aged <70 years (postoperative mortality: 9% vs 3%; P = .04; complications: 42% vs 32%; P = .0009). The 5-year OS, DSS, and RFS rates were significantly poorer than those for patients aged <70 years (OS: 42% vs 56%; P < .0001; DSS: 53% vs 61%; P = .04; RFS: 46% vs 54%; P = .03). Surgical margin status and primary tumor histology were independent predictors of OS, DSS, and RFS in multivariate analysis.
  
  
  CONCLUSIONS
  CFR for malignant skull base tumors in elderly patients (aged ≥70 years) was associated with increased mortality, complications, and poorer outcomes compared with patients aged <70 years.
authors.affiliation: Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Ganly
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Giulo
authors.initials: G
authors.lastname: Cantu
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Luiz P
authors.initials: LP
authors.lastname: Kowalski
authors.forename: Carl
authors.initials: C
authors.lastname: Snyderman
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003131:Combined Modality Therapy; D015897:Comorbidity; D005145:Face / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012886:Skull / Q000601:surgery; D019292:Skull Base Neoplasms / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome