诱导化疗联合同期放化疗与同期放化疗治疗局部晚期老年鼻咽癌患者的比较。

Induction plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy in elderly patients with locoregionally advanced nasopharyngeal carcinoma.

机构信息

Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China; Department of Experimental Research, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.

出版信息

Radiother Oncol. 2024 Nov;200:110497. doi: 10.1016/j.radonc.2024.110497. Epub 2024 Aug 25.

DOI:10.1016/j.radonc.2024.110497

PMID:39191301

Abstract

BACKGROUND

The effectiveness and safety of induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT) in elderly patients with locoregionally advanced nasopharyngeal carcinomas (LANPCs) remain subjects of debate. This study evaluated the efficacy of IC+CCRT compared to CCRT alone in elderly LANPC patients.

MATERIALS AND METHODS

This retrospective, single-center study analyzed 335 elderly patients diagnosed with stage III or IVa NPC who received CCRT with or without IC between 2010 and 2016. Kaplan-Meier analysis and log-rank tests were used to estimate and compare survival rates. Multivariate analysis using Cox proportional hazards regression model was conducted to assess prognostic risk factors. Toxicities were compared using the χ test.

RESULTS

The median follow-up duration was 69.3 months (interquartile range: 42.7-72.6). Baseline clinical characteristics were well-balanced between groups. No significant differences were observed between IC+CCRT and CCRT for any survival-related endpoints, including overall survival (hazard ratio [HR] = 1.26, 95 % confidence interval [CI]: 0.89-1.77, p = 0.188), locoregional relapse-free survival (HR=1.03, 95 % CI: 0.56-1.91, p = 0.913), distant metastasis-free survival (HR=1.39, 95 % CI: 0.90-2.16, p = 0.139), and failure-free survival (HR = 1.25, 95 % CI: 0.85-1.83, p = 0.255). However, the incidence and severity of acute and late toxicities were significantly higher in the IC+CCRT group compared to the CCRT group.

CONCLUSION

In elderly LANPC patients, the addition of IC to CCRT did not improve survival outcomes, but was associated with significant toxicities.

摘要

背景

诱导化疗（IC）联合同期放化疗（CCRT）在局部晚期老年鼻咽癌（LANPC）患者中的有效性和安全性仍存在争议。本研究评估了 IC+CCRT 对比单纯 CCRT 在老年 LANPC 患者中的疗效。

材料和方法

本回顾性单中心研究分析了 2010 年至 2016 年间接受 CCRT 联合或不联合 IC 治疗的 335 例 III 或 IVa 期 NPC 老年患者。采用 Kaplan-Meier 分析和对数秩检验估计和比较生存率。采用 Cox 比例风险回归模型进行多变量分析，评估预后危险因素。采用 χ 检验比较毒性。

结果

中位随访时间为 69.3 个月（四分位距：42.7-72.6）。两组间基线临床特征均衡。IC+CCRT 组与 CCRT 组在任何生存相关终点方面均无显著差异，包括总生存（风险比 [HR] = 1.26，95%置信区间 [CI]：0.89-1.77，p = 0.188）、局部区域无复发生存（HR = 1.03，95%CI：0.56-1.91，p = 0.913）、远处无转移生存（HR = 1.39，95%CI：0.90-2.16，p = 0.139）和无失败生存（HR = 1.25，95%CI：0.85-1.83，p = 0.255）。然而，IC+CCRT 组的急性和晚期毒性的发生率和严重程度明显高于 CCRT 组。