We report the experience of two French cancer centers in the treatment of oral cavity squamous cell carcinoma (SCC) in patients aged ⩾80years.Two hundred and sixty patients aged ⩾80years with a primary oral cavity SCC were included in this retrospective analysis.Sex ratio was near to 1. Tobacco or alcohol intoxication was the main risk factor for 66% of men and 16% of women and leukoplakia, lichen planus, or oral traumatism for 55% of women and 11% of men (p<0.0001). Two hundred patients received a loco-regional (LR) treatment with a curative intent (surgery and/or radiotherapy), 29 with a palliative intent and 31 did not receive a LR treatment. Curative treatments were initially planned to be adapted to age in 118 patients (59%). The median disease-specific survival (DSS) was 29months. In multivariate analysis, the independent prognostic factors for DSS were stage (HR=0.42 [0.24–0.72]), age (HR=0.43 [0.24–0.75]) and performance status (HR=0.50 [0.27–0.95]). The median overall survival (OS) was 14months. In multivariate analysis, the independent prognostic factors for OS were age (HR=0.52 [0.35–0.79]), stage (HR=0.56 [0.38–0.84]), tumor differentiation (HR=0.60 [0.33–0.93]) and performance status (HR=0.6 [0.37–0.97]). In patients treated with a curative intent, treatment adapted to age was not associated with a decreased overall survival or disease-specific survival as compared with the standard treatment. However, prophylactic lymph node treatment in stages I–II tumors decreased the rate of nodal recurrence from 38% to 6% (p=0.01).This study emphasizes the need for prospective evaluation of standard and adapted schedules in elderly patients with oral cavity cancer.