Yu Yi-Feng, Zhou Ping, Zhou Rui, Lin Qin, Wu San-Gang
Department of Radiation Oncology, Xiamen Cancer Quality Control Center, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Ann Med. 2024 Dec;56(1):2383959. doi: 10.1080/07853890.2024.2383959. Epub 2024 Jul 31.
The therapeutic benefit of concurrent chemoradiotherapy (CCRT) in elderly nasopharyngeal carcinoma (NPC) patients remains controversial. This study aimed to investigate the efficacy and toxicity of lobaplatin-based CCRT in elderly patients with NPC.
We included stage II-IVA NPC patients aged ≥65 years who received lobaplatin concomitant with intensity-modulated radiation therapy (IMRT) between March 2019 and January 2023. Objective response rates and treatment-related toxicity were assessed. Kaplan-Meier's analysis was performed to calculate survival rates.
A total of 29 patients were included with a median age of 67 years. There were 19 patients (65.5%) who had comorbidities. All patients had serum EBV-DNA detective before treatment; the median EBV-DNA load was 236 IU/mL. There were 25 (86.2%) patients treated with induction chemotherapy, and the overall response rate was 92.0%. All patients received IMRT and concurrent chemotherapy with lobaplatin. During the CCRT, the most common adverse effect was haematological toxicity. Three patients (10.3%) had grade 3 leucopenia, three patients (10.3%) had grade 3 neutropenia, and eight patients (27.6%) had grade 3-4 thrombocytopenia. The rate of grade 3 mucositis was 34.5%. No patients had liver and kidney dysfunction. The median weight loss was 4 kg during CCRT. After three months of CCRT, the total response rate was 100%. EBV-DNA was not detected in any patients. The median follow-up was 32.1 months. The 3-year locoregional recurrence-free survival, distant metastasis-free survival, progression-free survival and overall survival were 95.8%, 85.7%, 82.5% and 100%, respectively.
Lobaplatin-based CCRT is safe and feasible for elderly NPC patients, with satisfactory short-term survival outcomes and acceptable toxicities. A phase 2 trial is ongoing to investigate the role of lobaplatin-based CCRT on long-term survival and treatment toxicities for this population.
同步放化疗（CCRT）在老年鼻咽癌（NPC）患者中的治疗益处仍存在争议。本研究旨在探讨基于洛铂的CCRT在老年NPC患者中的疗效和毒性。
我们纳入了2019年3月至2023年1月期间年龄≥65岁、接受洛铂同步调强放射治疗（IMRT）的II-IVA期NPC患者。评估客观缓解率和治疗相关毒性。采用Kaplan-Meier分析计算生存率。
共纳入29例患者，中位年龄67岁。19例患者（65.5%）有合并症。所有患者治疗前血清EBV-DNA均呈阳性；中位EBV-DNA载量为236 IU/mL。25例患者（86.2%）接受了诱导化疗，总缓解率为92.0%。所有患者均接受IMRT和洛铂同步化疗。在CCRT期间，最常见的不良反应是血液学毒性。3例患者（10.3%）出现3级白细胞减少，3例患者（10.3%）出现3级中性粒细胞减少，8例患者（27.6%）出现3-4级血小板减少。3级黏膜炎发生率为34.5%。无患者出现肝肾功能障碍。CCRT期间中位体重减轻4 kg。CCRT三个月后，总缓解率为100%。所有患者均未检测到EBV-DNA。中位随访时间为32.1个月。3年局部区域无复发生存率、远处转移无复发生存率、无进展生存率和总生存率分别为95.8%、85.7%、82.5%和100%。
基于洛铂的CCRT对老年NPC患者安全可行，短期生存结果满意，毒性可接受。一项2期试验正在进行，以研究基于洛铂的CCRT对该人群长期生存和治疗毒性的作用。
