Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, China.
Department of Oncology, Baise People Hospital, 533000, Baise, China.
Strahlenther Onkol. 2020 Mar;196(3):270-279. doi: 10.1007/s00066-019-01533-7. Epub 2019 Nov 20.
The efficacy and tolerability of adding chemotherapy to radiotherapy in the era of intensity-modulated radiation therapy (IMRT) remain controversial among older patients with nasopharyngeal carcinoma (NPC). The present study compared IMRT alone with IMRT in combination with chemotherapy in elderly NPC patients.
Between January 2011 and December 2014, 102 patients aged >65 years with NPC who received IMRT alone (IMRT group) or IMRT in combination with chemotherapy (IMRT/CT group) were enrolled. Patients from both treatment arms were pair-matched (1:1 ratio) based on six clinical factors. Differences in overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan-Meier method and Cox proportional hazards models, whereas the toxicity profile was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4.
No significant differences were noted in OS (72.1% vs. 72.5%, p = 0.799), DFS (65.9% vs. 70.1%, p = 0.733), LRRFS (76.4% vs. 71.6%, p = 0.184), and DMFS (90.8% vs. 98.0%, p = 0.610) between the IMRT and IMRT/CT groups. Multivariate analyses showed that chemotherapy was not an independent factor for OS, DFS, LRRFS, and DMFS. However, the incidences of grade 3 vomiting/nausea (p = 0.000), leukopenia/neutropenia (p = 0.000), thrombocytopenia (p = 0.041), and anemia (p = 0.040) were significantly higher in the IMRT/CT group compared with the IMRT group. No grade 4 toxicities were observed.
IMRT alone was similar to IMRT/CT in treating elderly NPC patients (age >65 years), with comparable survival outcomes and less grade 3 toxicities.
在调强放疗（IMRT）时代，化疗联合放疗对老年鼻咽癌（NPC）患者的疗效和耐受性仍存在争议。本研究比较了单纯 IMRT 与 IMRT 联合化疗治疗老年 NPC 患者的效果。
2011 年 1 月至 2014 年 12 月，102 例年龄>65 岁的 NPC 患者接受单纯 IMRT（IMRT 组）或 IMRT 联合化疗（IMRT/CT 组）。根据 6 个临床因素，将两组患者进行 1:1 配对。采用 Kaplan-Meier 法和 Cox 比例风险模型评估总生存期（OS）、无病生存期（DFS）、局部区域无复发生存率（LRRFS）和无远处转移生存期（DMFS）的差异，采用不良事件通用术语标准（CTCAE）第 4 版评估毒性谱。
IMRT 组和 IMRT/CT 组的 OS（72.1% vs. 72.5%，p=0.799）、DFS（65.9% vs. 70.1%，p=0.733）、LRRFS（76.4% vs. 71.6%，p=0.184）和 DMFS（90.8% vs. 98.0%，p=0.610）差异均无统计学意义。多因素分析显示，化疗不是 OS、DFS、LRRFS 和 DMFS 的独立因素。然而，IMRT/CT 组的 3 级呕吐/恶心（p=0.000）、白细胞减少/中性粒细胞减少（p=0.000）、血小板减少（p=0.041）和贫血（p=0.040）发生率明显高于 IMRT 组。未观察到 4 级毒性。
单纯 IMRT 与 IMRT/CT 治疗老年 NPC 患者（年龄>65 岁）疗效相似，生存结局相当，3 级毒性更小。
