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A matched cohort study of standard chemo-radiotherapy versus radiotherapy alone in elderly nasopharyngeal carcinoma patients.

Zeng Q, Xiang YQ, Wu PH, Lv X, Qian CN, Guo X - PLoS ONE (2015)

Bottom Line: There was no significant difference in 5-year D-FFS between the two groups (75% vs. 73%, P=0.456).The CRT group experienced significantly more Grade ≥3 acute mucositis (46.0% vs. 28.7%, P= 0.019).When the elderly NPC patients are in good performance status following a complete evaluation of overall functional status and comorbidity conditions, standard chemo-radiotherapy is worthy of recommendation.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.

ABSTRACT
The impact of standard chemo-radiotherapy (CRT) as preferred therapy for elderly patients (age≥60 years) with nasopharyngeal carcinoma (NPC) remains unclear. Therefore, a strict matched cohort study was conducted to compare the survival and treatment toxicity of standard chemo-radiotherapy in the elderly NPC patients with those of radiotherapy (RT) alone. From 1998 to 2003, total 498 newly diagnosed elderly non-metastatic NPC patients were abstracted and classified into two groups by the treatments they received. For each patient in the CRT group, a matched pair in RT group was identified by matching for gender, age, histological type, T and N classifications, RT dose to primary tumor and neck nodes, and days of radiotherapy. Treatment tolerability and toxicity were clarified, and treatment outcomes were calculated and compared between the two groups. Two groups were well balanced in clinical characteristics because of the strict matching conditions. Totally 87 pairs can be assessed according to the criteria. The 5-year OS, CSS, FFS, and LR-FFS for CRT and RT groups were 62% versus 40% (P=0.013), 67% versus 47% (P=0.018), 65% versus 53% (log-rank: P=0.064, Breslow: P=0.048), and 88% versus 72%, (P=0.019), respectively. There was no significant difference in 5-year D-FFS between the two groups (75% vs. 73%, P=0.456). The CRT group experienced significantly more Grade ≥3 acute mucositis (46.0% vs. 28.7%, P= 0.019). We concluded that standard chemo-radiotherapy can achieve a reasonable local and regional control in elderly NPC patients with acceptable and reversible acute toxicity. However, distant metastasis remains the dominant failure pattern. When the elderly NPC patients are in good performance status following a complete evaluation of overall functional status and comorbidity conditions, standard chemo-radiotherapy is worthy of recommendation.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patients.Footnote: NPC, Nasopharyngeal carcinoma; RT, Radiotherapy; CRT, Chemoradiotherapy; CT, Chemotherapy.
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pone.0119593.g001: Flowchart of patients.Footnote: NPC, Nasopharyngeal carcinoma; RT, Radiotherapy; CRT, Chemoradiotherapy; CT, Chemotherapy.

Mentions: Fig. 1 showed the flowchart of patients. Totally 498 eligible cases of elderly NPC patients were included in this study. The elderly patients were classified into two groups by the treatments they received, basically with or without chemotherapy. For each patient in the CRT group, a matched pair in RT group (the reference group) was identified by matching for gender, age (the difference of two group, ≤ 3 years), histological type, T and N classifications (Chinese 1992 staging system)[14–15], radiotherapy dose to primary tumor (the difference of two groups, ≤ 2Gy) and neck nodes (the difference of two groups, ≤ 2Gy), and days of radiotherapy (the difference of two groups, ≤ 5 days). For the cases a matched pair could not be appropriately identified were dropped from the subsequent analysis. Whenever multiple matches were possible, the RT patient whose treatment date was closest to the CRT group patient was selected. Data were manually cross-checked after export to SPSS, with random-sampling verification of the matching process.


A matched cohort study of standard chemo-radiotherapy versus radiotherapy alone in elderly nasopharyngeal carcinoma patients.

Zeng Q, Xiang YQ, Wu PH, Lv X, Qian CN, Guo X - PLoS ONE (2015)

Flowchart of patients.Footnote: NPC, Nasopharyngeal carcinoma; RT, Radiotherapy; CRT, Chemoradiotherapy; CT, Chemotherapy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4359128&req=5

pone.0119593.g001: Flowchart of patients.Footnote: NPC, Nasopharyngeal carcinoma; RT, Radiotherapy; CRT, Chemoradiotherapy; CT, Chemotherapy.
Mentions: Fig. 1 showed the flowchart of patients. Totally 498 eligible cases of elderly NPC patients were included in this study. The elderly patients were classified into two groups by the treatments they received, basically with or without chemotherapy. For each patient in the CRT group, a matched pair in RT group (the reference group) was identified by matching for gender, age (the difference of two group, ≤ 3 years), histological type, T and N classifications (Chinese 1992 staging system)[14–15], radiotherapy dose to primary tumor (the difference of two groups, ≤ 2Gy) and neck nodes (the difference of two groups, ≤ 2Gy), and days of radiotherapy (the difference of two groups, ≤ 5 days). For the cases a matched pair could not be appropriately identified were dropped from the subsequent analysis. Whenever multiple matches were possible, the RT patient whose treatment date was closest to the CRT group patient was selected. Data were manually cross-checked after export to SPSS, with random-sampling verification of the matching process.

Bottom Line: There was no significant difference in 5-year D-FFS between the two groups (75% vs. 73%, P=0.456).The CRT group experienced significantly more Grade ≥3 acute mucositis (46.0% vs. 28.7%, P= 0.019).When the elderly NPC patients are in good performance status following a complete evaluation of overall functional status and comorbidity conditions, standard chemo-radiotherapy is worthy of recommendation.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Medical Imaging & Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China.

ABSTRACT
The impact of standard chemo-radiotherapy (CRT) as preferred therapy for elderly patients (age≥60 years) with nasopharyngeal carcinoma (NPC) remains unclear. Therefore, a strict matched cohort study was conducted to compare the survival and treatment toxicity of standard chemo-radiotherapy in the elderly NPC patients with those of radiotherapy (RT) alone. From 1998 to 2003, total 498 newly diagnosed elderly non-metastatic NPC patients were abstracted and classified into two groups by the treatments they received. For each patient in the CRT group, a matched pair in RT group was identified by matching for gender, age, histological type, T and N classifications, RT dose to primary tumor and neck nodes, and days of radiotherapy. Treatment tolerability and toxicity were clarified, and treatment outcomes were calculated and compared between the two groups. Two groups were well balanced in clinical characteristics because of the strict matching conditions. Totally 87 pairs can be assessed according to the criteria. The 5-year OS, CSS, FFS, and LR-FFS for CRT and RT groups were 62% versus 40% (P=0.013), 67% versus 47% (P=0.018), 65% versus 53% (log-rank: P=0.064, Breslow: P=0.048), and 88% versus 72%, (P=0.019), respectively. There was no significant difference in 5-year D-FFS between the two groups (75% vs. 73%, P=0.456). The CRT group experienced significantly more Grade ≥3 acute mucositis (46.0% vs. 28.7%, P= 0.019). We concluded that standard chemo-radiotherapy can achieve a reasonable local and regional control in elderly NPC patients with acceptable and reversible acute toxicity. However, distant metastasis remains the dominant failure pattern. When the elderly NPC patients are in good performance status following a complete evaluation of overall functional status and comorbidity conditions, standard chemo-radiotherapy is worthy of recommendation.

No MeSH data available.


Related in: MedlinePlus