Age ≥75 with ECOG ≥2 or ≥2 comorbidities — cisplatin + RT and trastuzumab + chemotherapy...

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ID	`RF-SALIVARY-FRAILTY-AGE`
Tipo	Sinal de alerta
Estado	reviewed 2026-04-27 \| pending_clinical_signoff
Doenças	`DIS-SALIVARY`
Fontes	`SRC-ESMO-SALIVARY` `SRC-NCCN-HEAD-AND-NECK`

Origem da bandeira vermelha

Definição	Age ≥75 with ECOG ≥2 or ≥2 comorbidities — cisplatin + RT and trastuzumab + chemotherapy combinations poorly tolerated; AR-targeted therapy (bicalutamide + LHRH for AR+ SDC) is favored low-toxicity alternative; for indolent histologies (low-grade mucoepidermoid / acinic cell), watchful waiting is appropriate.
Direcção clínica	de escalonamento
Categoria	Idade de fragilidade

Lógica de Desencadeamento

{
  "all_of": [
    {
      "comparator": ">=",
      "finding": "age_years",
      "threshold": 75
    },
    {
      "any_of": [
        {
          "comparator": ">=",
          "finding": "ecog_status",
          "threshold": 2
        },
        {
          "comparator": ">=",
          "finding": "comorbidity_count",
          "threshold": 2
        }
      ]
    }
  ],
  "type": "composite_clinical"
}

Notas

Salivary gland cancers span indolent (low-grade mucoepidermoid, acinic cell — 10-yr OS >80%) to aggressive (salivary duct, high-grade transformation — 5-yr OS ~30%); frailty-age framing must consider histology + AR / HER2 / NTRK status. Cisplatin-CRT in elderly carries high mucositis + nephrotoxicity rates. Bicalutamide + LHRH (AR+ SDC) is well-tolerated even in elderly — comparable efficacy to chemotherapy with much lower toxicity (EORTC-1206). Larotrectinib / entrectinib (NTRK+) similar — well-tolerated. Geriatric assessment (G8) ≥70 recommended before chemoradiation. Consider IMRT alone (without chemo) for elderly with locally advanced disease + organ dysfunction.

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