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

Radiation Oncology

Hai-Qiang Mai²  Ming-Huang Hong¹  Ka-Jia Cao²  Xiang Guo²  Rui Sun²  Dong-Hua Luo²  Pei-Yu Huang²  Zong-Liang Zhong²  Hao-Yuan Mo²  Lin-Quan Tang²  Ling Guo²  Qiu-Yan Chen²  Huai Liu² 

[1] Good Clinical Practice (GCP) Center, Sun Yat-sen University Cancer Center, Guangzhou, P.R. China;Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou 510060, P.R. China

关键词: Adult comorbidity evaluation-27;    Chemoradiotherapy;    Elderly;    Nasopharyngeal carcinoma;   

Others  :  1154345
DOI  :  10.1186/1748-717X-8-70

 received in 2012-06-07, accepted in 2013-03-19,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Liu et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Altun M, Fandi A, Dupuis O, Cvitkovic E, Krajina Z, Eschwege F: Undifferentiated nasopharyngeal cancer (UCNT): current diagnostic and therapeutic aspects. Int J Radiat Oncol Biol Phys 1995, 32:859-877.
• [2]Al-Sarraf M, LeBlanc M, Giri PG: Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 1998, 16:1310-1317.
• [3]Chen Y, Liu MZ, Liang SB: Preliminary results of a prospective randomized trial comparing concurrent chemoradiotherapy plus adjuvant chemotherapy with radiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma in endemic regions of china. Int J Radiat Oncol Biol Phys 2008, 71:1356-1364.
• [4]Kwong DL, Sham JS, Au GK: Concurrent and adjuvant chemotherapy for nasopharyngeal carcinoma: a factorial study. J Clin Oncol 2004, 22:2643-2653.
• [5]Lee AW, Tung SY, Chua DT: Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst 2010, 102:1188-1198.
• [6]Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY: Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 2003, 21:631-637.
• [7]Wee J, Tan EH, Tai BC: Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety. J Clin Oncol 2005, 23:6730-6738.
• [8]Lee L, Cheung WY, Atkinson E, Krzyzanowska MK: Impact of comorbidity on chemotherapy Use and outcomes in solid tumors: a systematic review. J Clin Oncol 2011, 29:106-117.
• [9]Pignon T, Horiot JC, Van den Bogaert W, Van Glabbeke M, Scalliet P: No age limit for radical radiotherapy in head and neck tumours. Eur J Cancer 1996, 32A:2075-2081.
• [10]Sze HC, Ng WT, Chan OS, Shum TC, Chan LL, Lee AW: Radical radiotherapy for nasopharyngeal carcinoma in elderly patients: the importance of co-morbidity assessment. Oral Oncol 2012, 48:162-167.
• [11]Guo QJ, Jiang WP, Lin SJ: Radiation therapy for locoregionally advanced nasopharyngeal carcinoma in elderly patients. J Radiat Oncol 2012, 1:323-332.
• [12]Compton CC, Byrd DR, Garcia-Aguilar J, Kurtzman SH: Alexander Olawaiye, and Mary Kay Washington: Pharynx. In AJCC Cancer Staging Atlas. 2nd edition. New York: Springer; 2012:55-77.
• [13]Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr, Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr: Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004, 291:2441-2447.
• [14]Lu TX, Luo W, Zhao C: A probe of design methods of block shielding facio-cervical portals at isocenter for radiotherapy of nasopharyngeal carcinoma. Chin J Cancer 2000, 19:930-933.
• [15]Kaplan E, Meier P: Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958, 53:457-481.
• [16]Peto R, Pike MC, Armitage P: Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer 1977, 35:1-39.
• [17]CTCAE v3.0. [http://www.eortc.be/services/doc/ctc/ctcaev3.pdf webcite]
• [18]RTOG/EORTC Late Radiation Morbidity Scoring Schema. [http://www.rtog.org/ResearchAssociates/AdverseEventReporting/RTOGEORTCLateRadiationMorbidityScoringSchema.aspx webcite]
• [19]Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ: The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 2004, 22:4604-4612.
• [20]Baujat B, Audry H, Bourhis J: Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients. Int J Radiat Oncol Biol Phys 2006, 64:47-56.
• [21]Zhang L, Zhao C, Ghimire B: The role of concurrent chemoradiotherapy in the treatment of locoregionally advanced nasopharyngeal carcinoma among endemic population: a meta-analysis of the phase III randomized trials. BMC Cancer 2010, 10:558. BioMed Central Full Text
• [22]Lee AW, Lau WH, Tung SY: Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 2005, 23:6966-6975.
• [23]Chen QY, Wen YF, Guo L: Concurrent chemoradiotherapy vs radiotherapy alone in stage II nasopharyngeal carcinoma: phase III randomized trial. J Natl Cancer Inst 2011, 103:1761-1770.
• [24]Chan AT, Teo PM, Ngan RK: Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 2002, 20:2038-2044.
• [25]Michal SA, Adelstein DJ, Rybicki LA: Multi-agent concurrent chemoradiotherapy for locally advanced head and neck squamous cell cancer in the elderly. Head Neck 2011, 34(8):1147-1152.
• [26]Al-Sarraf M, LeBlanc M, Giri PG: Superiority of five year survival with chemo-radiotherapy (CT-RT) vs radiotherapy in patients (Pts) with locally advanced nasopharyngeal cancer (NPC). intergroup (0099) (SWOG 8892, RTOG 8817, ECOG 2388) phase III study: final report [abstract]. Proc Am Soc Clin Oncol 2001., 20Abstract 905
• [27]Chan AT, Leung SF, Ngan RK: Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. J Natl Cancer Inst 2005, 97:536-9.
• [28]Qi SN, Xie FY, Lu TX, Gao JM, Liu MZ, Zou GR: Clinical characters of aged nasopharyngeal carcinoma patients. Ai Zheng 2006, 25:740-3.
• [29]Zeng Q, Guo X, Li NW, Xiang YQ, Cao SM, Hong MH: Clinical characteristics and prognosis of aged nasopharyngeal carcinoma patients: a report of 313 cases. Ai Zheng 2008, 27:289-94.
• [30]Pignon JP, le Maitre A, Maillard E, Bourhis J: Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009, 92:4-14.
• [31]Ho HC, Su YC, Lee MS: A preliminary result of concurrent chemoradiation with weekly cisplatin in elderly nasopharyngeal carcinoma patients. Acta Otolaryngol 2008, 128:930-5.