Abstract
Older patients are at increased risk of toxicities from aggressive oncologic therapy and of nononcologic death. A meta‐analysis of non‐nasopharyngeal head and neck cancers showed no statistical benefit in adding chemotherapy to radiotherapy (RT) in older patients; another meta‐analysis of RT versus chemoradiotherapy (CRT) in NPC found advantages to CRT, but vastly under‐represented patients ≥70 years old. This is the largest study to date evaluating outcomes of CRT versus RT alone in this population. The National Cancer Data Base (NCDB) was queried for primary nasopharyngeal cancer cases (2004–2013) in patients ≥70 years old receiving RT alone or CRT. Patients with unknown RT/chemotherapy and T1N0 or M1 disease were excluded. Logistic regression analysis ascertained factors associated with CRT delivery. Kaplan–Meier analysis evaluated overall survival (OS) between both cohorts. Cox proportional hazards modeling determined variables associated with OS. In total, 930 patients were analyzed (n = 713 (77%) CRT, n = 217 (23%) RT). Groups were relatively balanced; CRT was less frequently delivered in patients with advancing age, lower nodal burden, and females (P < 0.05 for all). Median OS in the CRT and RT groups were 35.3 versus 20.0 months, respectively (P = 0.002). On multivariate analysis, independent predictors of OS included age, comorbidities, income and insurance status, tumor grade, and stage (P < 0.05 for all). Notably, receipt of chemotherapy independently predicted for improved OS (P = 0.036). CRT, compared to RT alone, was independently associated with improved survival in NPC patients ≥70 years old. CRT appears to be a promising approach in this population, but treatment‐related toxicity risks should continue to be weighed against potential oncologic benefits.
Highlights
Numerous clinical trials have demonstrated survival improvements with the addition of chemotherapy to definitive radiation therapy (RT) for head and neck cancers, as highlighted by the MACH-N C meta-analysis [1]
The largest such study to date, we evaluated national practice patterns and outcomes in older nasopharyngeal cancer (NPC) patients treated with CRT versus RT alone
The National Cancer Data Base (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society, which consists of de-identified information regarding tumor characteristics, patient demographics, and patient survival for approximately 70% of the United States population [8,9,10,11,12,13,14,15]
Summary
Numerous clinical trials have demonstrated survival improvements with the addition of chemotherapy to definitive radiation therapy (RT) for head and neck cancers, as highlighted by the MACH-N C meta-analysis [1]. The meta-analysis did not evaluate toxicities, numerous studies have illustrated decreased tolerance of oncologic therapies by older patients [2,3,4]. A factor limiting applicability of the MACH-NC report was its specific exclusion of nasopharyngeal cancer (NPC). This neoplasm, rare in the United States but endemic in south China and north Africa, is most commonly treated with chemoradiotherapy (CRT) [5]. This paradigm is supported by the MAC-NPC meta-analysis, which
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
