Abstract
BackgroundTo clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC).MethodsFrom January 2000 to December 2006, 101 newly diagnosed elderly non-metastatic NPC patients (age≥65 years) who received cisplatin 3-weekly or weekly concurrent CRT with/without sequential chemotherapy were recruited. Each patient from the CRT group was matched to another patient treated with radiotherapy (RT) alone based on age, gender, pathological type, performance status, overall stage, stage method, Adult Comorbidity Evaluation-27 (ACE-27) score and RT technique, from the same institute and time period. We also recruited 101 young patients (age<65 years) as the referent group, which had been matched to the CRT group based on patient characteristics and treatment parameters. Treatment tolerability and toxicity were clarified, and treatment outcomes were calculated and compared among groups.ResultsCRT was feasible in elderly NPC patients, while a concurrent regimen of weekly cisplatin was more tolerable. Grade≥3 acute toxicity in CRT group was similar with referent group, although it was significantly higher than the RT alone group (65.3% vs. 43.6%, P=0.002). Furthermore, patients with ACE-27 score≥2 in the CRT group had significantly higher severe acute toxicity and dose reduction. Survival was poorer in elderly patients than the referent group. Compared to RT alone, CRT significantly improved the 5-year overall survival (OS: 54.6% vs. 39.3%, P=0.009), cancer-specific survival (CSS: 56.6% vs. 42.7%, P=0.022), disease-free survival (DFS: 51.6% vs. 30.2%, P=0.028) and locoregional relapse-free survival (LRRFS: 78.4% vs. 52.2%, P=0.003), but not distant metastasis-free survival (DMFS: 69.6% vs. 63.6%, P=0.669). However, CRT did not significantly improve 5-year OS (43.6% vs. 27.3%, P=0.893) or CSS (43.6% vs. 34.1%, P=0.971) in elderly NPC patients with ACE-27 score≥2.ConclusionsCRT is feasible and effective in elderly patients with locoregionally advanced NPC without severe comorbidities. CRT should be used under serious consideration and be further tested in elderly patients with severe comorbidities. As such, it is essential to perform a comprehensive evaluation of pretreatment comorbidity status for all elderly NPC patients.
Highlights
To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly patients with locoregionally advanced nasopharyngeal carcinoma (NPC)
Selection criteria for CRT cases included the following patients: the elderly; those with newly diagnosed NPC without metastasis; those with stage III-IVb disease (the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/Union for international cancer control (UICC)) staging system) ([12], Additional file 1), where patients assessed with a former staging system were re-staged according to the 7th American joint committee on cancer (AJCC)/UICC staging system; those who finished radical RT in the end; those treated with concurrent referent group, and patient characteristics and treatment parameters were matched to the CRT group
We found that CRT could still significantly improve 5-year overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and locoregional relapse-free survival (LRRFS) but not distant metastasis-free survival (DMFS) when compared to RT alone in elderly NPC patients
Summary
To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC). The Intergroup Study 0099 and several other prospective randomized trials that were conducted in endemic areas have demonstrated that, compared to radiotherapy (RT) alone, concurrent chemoradiotherapy (CRT) with/without adjuvant chemotherapy could significantly improve survival of locoregionally advanced NPC, with higher rates of acute toxicities [2,3,4,5,6,7]. When faced with the choice between benefits and toxicities caused by CRT, many oncologists prefer RT alone, which was already demonstrated to be tolerable in elderly patients with head and neck cancers and NPC [9,10,11], this conservative treatment selection may prevent some elderly patients from longer survival. We conducted a matched cohort analysis to analyze the feasibility and efficacy of CRT in elderly locoregionally advanced NPC patients
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