Cao Caineng, Fang Yuting, Jiang Feng, Jin Qifeng, Jin Ting, Huang Shuang, Hu Qiaoying, Chen Yuanyuan, Piao Yongfeng, Hua Yonghong, Feng Xinglai, Chen Xiaozhong
Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Postgraduate training base Alliance of Wenzhou Medical University, China.
Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Postgraduate training base Alliance of Wenzhou Medical University, China.
J Geriatr Oncol. 2025 Jun;16(5):102246. doi: 10.1016/j.jgo.2025.102246. Epub 2025 May 15.
We aimed to evaluate the efficacy of two different radiotherapy strategies in elderly patients with locally advanced nasopharyngeal carcinoma (NPC) using geriatric assessment.
We conducted a randomized phase 2 trial for older patients (≥ 65 years) with stage III-IVA NPC. Patients were randomized into either intensity-modulated radiotherapy (IMRT) alone (RT Arm) or concurrent chemoradiotherapy (CCRT Arm). The primary endpoint was therapeutic success. The secondary endpoints were survival, safety and geriatric assessment.
Between June 1, 2017 and June 11, 2019, 22 patients were allocated to the RT arm and 19 to the CCRT arm. There was therapeutic success in 11 patients (57.9 %) in the CCRT arm and 18 patients (81.8 %) in the RT arm. The median follow-up time was 60.4 months (interquartile range [IQR], 49.8-67.8) months. The five-year locoregional relapse-free survival, cancer-specific survival, and overall survival rates for patients in the CCRT and RT arms were 93.8 % and 85.7 % (p = 0.77), 93.8 % and 80.7 % (p = 0.12), 78.9 % and 56.8 % (p = 0.09), respectively. The five-year distant metastasis-free survival rates for patients in the CCRT and RT arms were 100.0 % and 76.6 % (p = 0.002), respectively. Compared with the CCRT arm, lower incidence of acute toxicities was observed in the RT arm, including grade 1 or higher vomiting, nausea, anemia, and leukopenia (p < 0.05).
CCRT was not more efficacious than IMRT alone but was more likely to cause acute toxicities in older patients with locally advanced NPC. CCRT should only be used in selected older patients with locally advanced NPC.
我们旨在通过老年评估来评估两种不同放疗策略对局部晚期鼻咽癌（NPC）老年患者的疗效。
我们对年龄≥65岁的III-IVA期NPC老年患者进行了一项随机2期试验。患者被随机分为单纯调强放疗组（放疗组）或同步放化疗组（CCRT组）。主要终点是治疗成功。次要终点是生存率、安全性和老年评估。
在2017年6月1日至2019年6月11日期间，22例患者被分配到放疗组，19例被分配到CCRT组。CCRT组有11例患者（57.9%）治疗成功，放疗组有18例患者（81.8%）治疗成功。中位随访时间为60.4个月（四分位间距[IQR]，49.8 - 67.8个月）。CCRT组和放疗组患者的五年局部区域无复发生存率、癌症特异性生存率和总生存率分别为93.8%和85.7%（p = 0.77）、93.8%和80.7%（p = 0.12）、78.9%和56.8%（p = 0.09）。CCRT组和放疗组患者的五年无远处转移生存率分别为100.0%和76.6%（p = 0.002）。与CCRT组相比，放疗组急性毒性的发生率较低，包括1级或更高等级的呕吐、恶心、贫血和白细胞减少（p < 0.05）。
对于局部晚期NPC老年患者，同步放化疗并不比单纯调强放疗更有效，但更有可能引起急性毒性。同步放化疗仅应用于选定的局部晚期NPC老年患者。
