Liu Huai, Chen Qiu-Yan, Guo Ling, Tang Lin-Quan, Mo Hao-Yuan, Zhong Zong-Liang, Huang Pei-Yu, Luo Dong-Hua, Sun Rui, Guo Xiang, Cao Ka-Jia, Hong Ming-Huang, Mai Hai-Qiang
Radiat Oncol. 2013 Mar 22;8:70. doi: 10.1186/1748-717X-8-70.
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.
背景：阐明放化疗（CRT）在老年（年龄≥65岁）局部晚期鼻咽癌（NPC）患者中的可行性和疗效。 方法：2000年1月至2006年12月，招募了101例新诊断的老年非转移性NPC患者（年龄≥65岁），这些患者接受了每3周或每周一次顺铂同步CRT，伴或不伴序贯化疗。CRT组的每例患者与另1例仅接受放疗（RT）的患者，根据年龄、性别、病理类型、体能状态、总体分期、分期方法、成人合并症评估-27（ACE-27）评分和RT技术进行匹配，来自同一机构和时间段。我们还招募了101例年轻患者（年龄<65岁）作为参照组，其已根据患者特征和治疗参数与CRT组进行匹配。明确了治疗耐受性和毒性，并计算和比较了各组的治疗结局。 结果：CRT在老年NPC患者中是可行的，而每周一次顺铂的同步方案耐受性更好。CRT组≥3级急性毒性与参照组相似，尽管显著高于单纯RT组（65.3%对43.6%，P=0.002）。此外，CRT组中ACE-27评分≥2的患者严重急性毒性和剂量降低显著更高。老年患者的生存率低于参照组。与单纯RT相比，CRT显著提高了5年总生存率（OS：54.6%对39.3%，P=0.009）、癌症特异性生存率（CSS：56.6%对42.7%，P=0.022）、无病生存率（DFS：51.6%对30.2%，P=0.028）和局部区域无复发生存率（LRRFS：78.4%对52.2%，P=0.003），但远处无转移生存率（DMFS：69.6%对63.6%，P=0.669）未显著提高。然而，CRT在ACE-27评分≥2的老年NPC患者中未显著提高5年OS（43.6%对27.3%，P=0.893）或CSS（43.6%对34.1%，P=0.971）。 结论：CRT在无严重合并症的老年局部晚期NPC患者中是可行且有效的。对于有严重合并症的老年患者，应慎重考虑使用CRT并进一步进行试验。因此，对所有老年NPC患者进行全面的预处理合并症状态评估至关重要。
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