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

• Published in: Radiotherapy and oncology Vol. 200; p. 110497
• Main Authors: Chen, Lin, Li, Kunpeng, Li, Qingjie, Ji, Pengjie, Huang, Chenglong, Tang, Linglong
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2024
• Subjects: Aged; Chemoradiotherapy - adverse effects; Concurrent chemoradiotherapy; Elderly patients; Female; Hematology, Oncology, and Palliative Medicine; Humans; Induction Chemotherapy; Kaplan-Meier Estimate; Male; Nasopharyngeal carcinoma; Nasopharyngeal Carcinoma - mortality; Nasopharyngeal Carcinoma - pathology; Nasopharyngeal Carcinoma - therapy; Nasopharyngeal Neoplasms - mortality; Nasopharyngeal Neoplasms - pathology; Nasopharyngeal Neoplasms - therapy; Neoplasm Staging; Prognosis; Retrospective Studies; Survival Rate; NPC; Prognosis; CTV; IMRT; GTV; HR; LRRFS; Nasopharyngeal carcinoma; FFS; UICC; Concurrent chemoradiotherapy; AJCC; EBV; IC; WHO; LANPC; Induction chemotherapy; OS; CI; EORTC; IQR; Elderly patients; DMFS; RTOG; CCRT; Hazard ratio; American Joint Committee on Cancer; Intensity modulated radiation therapy; Epstein-Barr virus; Clinical target volume; Union for International Cancer Control; World Health Organization; Distant metastasis-free survival; Radiation Therapy Oncology Group; Failure-free survival; Locoregionally advanced nasopharyngeal carcinoma; Confidence interval; Interquartile range; Locoregional relapse-free survival; Gross tumor volume; Overall survival; European Organization for Research and Treatment of Cancer
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2024.110497

•The addition of IC to CCRT does not confer a survival benefit to CCRT for elderly LANPC patients.•Patients in the IC+CCRT group experienced more sever acute and late toxicities.•CCRT should be considered as the optimal treatment for elderly LANPC. 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. 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 χ2 test. 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. In elderly LANPC patients, the addition of IC to CCRT did not improve survival outcomes, but was associated with significant toxicities.