Division of Radiation Oncology, National Cancer Centre, Singapore.
Division of Radiation Oncology, National Cancer Centre, Singapore.
J Geriatr Oncol. 2018 Jul;9(4):352-358. doi: 10.1016/j.jgo.2018.01.006. Epub 2018 Feb 9.
This study aimed to evaluate the predictive factors for survival and acute toxicities in older patients with NPC treated with curative intent IMRT.
Older patients aged 65 years and above with non-metastatic NPC treated with curative intent IMRT between 2003 and 2013 were retrospectively analysed. Variables examined were gender, age, overall stage, chemotherapy use, Eastern Cooperative Oncology Group (ECOG) performance status and comorbidity. The comorbidity severity was determined by adult comorbidity evaluation (ACE-27). We considered hospitalization or placement of feeding tube during and up to one month post radiotherapy as surrogate endpoint for significant acute toxicities. Other endpoints examined were: OS (overall survival), DFS (disease free survival), DSS (disease specific survival).
A total of 185 patients were eligible for analysis. Median age was 70 (65-86 years). Most of the patients presented with Stage III and IVA/B (n = 127, 68.7%), of good performance status of ECOG 0-1 (n = 176, 95.1%) and had low comorbidities with ACE-27 score of 0-1 (n = 141, 76.2%). Chemotherapy was delivered to 84 patients (45.4%). OS, DFS, and DSS were 64.5%, 51.4%, and 72.8% respectively. High comorbidity burden but not chemotherapy had significant impact on OS and DFS in patients with advanced stage. Fifty patients (27%) required tube feeding or hospitalization during the course of RT. Males, chemotherapy use and ECOG score ≥2 were significant predictors of tube feeding or hospitalization during RT.
Curative IMRT was associated with excellent survival outcomes in older patients with NPC. Comorbidity but not chemotherapy was associated with prognosis in advanced stage. Careful monitoring and intensive support should be instituted in older males with ECOG score ≥2 receiving chemo-radiotherapy.
本研究旨在评估接受根治性调强放疗（IMRT）的老年鼻咽癌（NPC）患者的生存和急性毒性的预测因素。
回顾性分析了 2003 年至 2013 年间接受根治性 IMRT 治疗的年龄在 65 岁及以上的非转移性 NPC 老年患者。检查的变量包括性别、年龄、总体分期、化疗使用、东部肿瘤协作组（ECOG）表现状态和合并症。合并症严重程度通过成人合并症评估（ACE-27）确定。我们将放疗期间和放疗后一个月内的住院或放置饲管作为严重急性毒性的替代终点。其他检查的终点包括：总生存期（OS）、无病生存期（DFS）、疾病特异性生存期（DSS）。
共有 185 例患者符合分析条件。中位年龄为 70 岁（65-86 岁）。大多数患者为 III 期和 IVA/B 期（n=127，68.7%），ECOG 表现状态良好为 0-1 级（n=176，95.1%），合并症低，ACE-27 评分为 0-1 级（n=141，76.2%）。84 例患者接受了化疗（45.4%）。OS、DFS 和 DSS 分别为 64.5%、51.4%和 72.8%。高合并症负担而非化疗对晚期患者的 OS 和 DFS 有显著影响。50 例患者（27%）在放疗过程中需要进行饲管喂养或住院治疗。男性、化疗使用和 ECOG 评分≥2 是放疗期间需要饲管喂养或住院的显著预测因素。
根治性 IMRT 为老年 NPC 患者带来了极好的生存结果。在晚期患者中，合并症而非化疗与预后相关。接受化疗放疗的 ECOG 评分≥2 的老年男性应进行密切监测和强化支持。
