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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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Related in: MedlinePlus

Kaplan-Meier estimates of the survival of elderly locoregionally advanced nasopharyngeal carcinoma patients, by treatment group (CRT vs. RT). (A) overall survival; (B) cancer-specific survival; (C) disease-free survival; (D) distant metastasis-free survival; and (E) locoregional relapse-free survival.
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Figure 2: Kaplan-Meier estimates of the survival of elderly locoregionally advanced nasopharyngeal carcinoma patients, by treatment group (CRT vs. RT). (A) overall survival; (B) cancer-specific survival; (C) disease-free survival; (D) distant metastasis-free survival; and (E) locoregional relapse-free survival.

Mentions: Our median follow-up period was 67.5 months (range: 8 to 114 months). One hundred and twenty-one deaths (52 from the CRT group vs. 69 from the RT group) were detected during the follow-up period, of which 104 (86.0%) were disease-related (44 in the CRT group vs. 57 in the RT group). Other causes of death included comorbidity (12 patients), old age (3 patients) and accidents (2 patients). The 5-year OS in the CRT group was 54.6% compared with 39.3% in the RT group (P=0.009, Figure 2A), with a hazard ratio of 0.619 (95% CI, 0.430-0.890; P=0.009). Thus, CRT decreased nearly 40% death risk in elderly locoregionally advanced NPC patients. Patients in the CRT group also had significantly higher 5-year CSS than did patients in the RT group (56.6% vs. 42.7%, P=0.022, Figure 2B). In the referent group, the 5-year OS and CSS were significantly higher than the CRT group (75.3% vs. 54.6%, P<0.001 and 77.8% vs. 56.6% P<0.001).


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)

Kaplan-Meier estimates of the survival of elderly locoregionally advanced nasopharyngeal carcinoma patients, by treatment group (CRT vs. RT). (A) overall survival; (B) cancer-specific survival; (C) disease-free survival; (D) distant metastasis-free survival; and (E) locoregional relapse-free survival.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Kaplan-Meier estimates of the survival of elderly locoregionally advanced nasopharyngeal carcinoma patients, by treatment group (CRT vs. RT). (A) overall survival; (B) cancer-specific survival; (C) disease-free survival; (D) distant metastasis-free survival; and (E) locoregional relapse-free survival.
Mentions: Our median follow-up period was 67.5 months (range: 8 to 114 months). One hundred and twenty-one deaths (52 from the CRT group vs. 69 from the RT group) were detected during the follow-up period, of which 104 (86.0%) were disease-related (44 in the CRT group vs. 57 in the RT group). Other causes of death included comorbidity (12 patients), old age (3 patients) and accidents (2 patients). The 5-year OS in the CRT group was 54.6% compared with 39.3% in the RT group (P=0.009, Figure 2A), with a hazard ratio of 0.619 (95% CI, 0.430-0.890; P=0.009). Thus, CRT decreased nearly 40% death risk in elderly locoregionally advanced NPC patients. Patients in the CRT group also had significantly higher 5-year CSS than did patients in the RT group (56.6% vs. 42.7%, P=0.022, Figure 2B). In the referent group, the 5-year OS and CSS were significantly higher than the CRT group (75.3% vs. 54.6%, P<0.001 and 77.8% vs. 56.6% P<0.001).

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