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Feasibility and efficacy of chemoradiotherapy for elderly patients with locoregionally advanced nasopharyngeal carcinoma: results from a matched cohort analysis.

Liu H, Chen QY, Guo L, Tang LQ, Mo HY, Zhong ZL, Huang PY, Luo DH, Sun R, Guo X, Cao KJ, Hong MH, Mai HQ - Radiat Oncol (2013)

Bottom Line: Furthermore, patients with ACE-27 score≥2 in the CRT group had significantly higher severe acute toxicity and dose reduction.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.CRT is feasible and effective in elderly patients with locoregionally advanced NPC without severe comorbidities.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods: From 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.

Results: CRT 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.

Conclusions: CRT 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.

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Flowchart of patients. NPC: Nasopharyngeal carcinoma; RT: Radiotherapy; CRT: Chemoradiotherapy; CT: Chemotherapy. *Other drugs included carboplatin (N=43), nedaplatin (N=28), paclitaxel (N=9), docetaxel (N=8), and Xeloda (N=7).
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Figure 1: Flowchart of patients. NPC: Nasopharyngeal carcinoma; RT: Radiotherapy; CRT: Chemoradiotherapy; CT: Chemotherapy. *Other drugs included carboplatin (N=43), nedaplatin (N=28), paclitaxel (N=9), docetaxel (N=8), and Xeloda (N=7).

Mentions: From January 2000 to December 2006, 11,173 newly diagnosed non-metastatic NPC patients were registered at Sun Yat-sen University Cancer Center, of them 804 (7.2%) patients were 65 years old or over. Figure 1 shows the flowchart of patients. Finally, 101 patients who met the above criteria were included in our CRT group. Each patient in the CRT group was matched with another patient from a group of 311 patients treated with RT alone at the same institution and during the same period. The matched prognostic factors included the following: age (65–69 years and ≥70 years), gender (male and female), pathological type (WHO types II-III and WHO type I), performance status (ECOG scores of 0–1 and 2), overall stage (stage III and IVa-b), stage method (CT and MRI), Adult Co-morbidity Evaluation-27 (ACE-27) ([13]; Additional file 2) scores (0–1 and 2–3) and RT techniques (2D conventional RT and 3D conformal RT or intensity-modulated radiotherapy (IMRT)). When an exact match was not available, a patient with more favorable characteristics from the RT alone group was selected to prevent results from being biased in favor of the CRT group. We also recruited 101 young patients (age<65 years) with locoregionally advanced NPC at the same institute and during the same time period as the referent group, and patient characteristics and treatment parameters were matched to the CRT group.


Feasibility and efficacy of chemoradiotherapy for elderly patients with locoregionally advanced nasopharyngeal carcinoma: results from a matched cohort analysis.

Liu H, Chen QY, Guo L, Tang LQ, Mo HY, Zhong ZL, Huang PY, Luo DH, Sun R, Guo X, Cao KJ, Hong MH, Mai HQ - Radiat Oncol (2013)

Flowchart of patients. NPC: Nasopharyngeal carcinoma; RT: Radiotherapy; CRT: Chemoradiotherapy; CT: Chemotherapy. *Other drugs included carboplatin (N=43), nedaplatin (N=28), paclitaxel (N=9), docetaxel (N=8), and Xeloda (N=7).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3643871&req=5

Figure 1: Flowchart of patients. NPC: Nasopharyngeal carcinoma; RT: Radiotherapy; CRT: Chemoradiotherapy; CT: Chemotherapy. *Other drugs included carboplatin (N=43), nedaplatin (N=28), paclitaxel (N=9), docetaxel (N=8), and Xeloda (N=7).
Mentions: From January 2000 to December 2006, 11,173 newly diagnosed non-metastatic NPC patients were registered at Sun Yat-sen University Cancer Center, of them 804 (7.2%) patients were 65 years old or over. Figure 1 shows the flowchart of patients. Finally, 101 patients who met the above criteria were included in our CRT group. Each patient in the CRT group was matched with another patient from a group of 311 patients treated with RT alone at the same institution and during the same period. The matched prognostic factors included the following: age (65–69 years and ≥70 years), gender (male and female), pathological type (WHO types II-III and WHO type I), performance status (ECOG scores of 0–1 and 2), overall stage (stage III and IVa-b), stage method (CT and MRI), Adult Co-morbidity Evaluation-27 (ACE-27) ([13]; Additional file 2) scores (0–1 and 2–3) and RT techniques (2D conventional RT and 3D conformal RT or intensity-modulated radiotherapy (IMRT)). When an exact match was not available, a patient with more favorable characteristics from the RT alone group was selected to prevent results from being biased in favor of the CRT group. We also recruited 101 young patients (age<65 years) with locoregionally advanced NPC at the same institute and during the same time period as the referent group, and patient characteristics and treatment parameters were matched to the CRT group.

Bottom Line: Furthermore, patients with ACE-27 score≥2 in the CRT group had significantly higher severe acute toxicity and dose reduction.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.CRT is feasible and effective in elderly patients with locoregionally advanced NPC without severe comorbidities.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods: From 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.

Results: CRT 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.

Conclusions: CRT 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.

Show MeSH
Related in: MedlinePlus