Objective This study aims to evaluate the risk stratification among elderly Nasopharyngeal carcinoma (NPC) patients (≥60 years old) and select the beneficiaries from concurrent chemotherapy (CCRT) combined with induction chemotherapy (IC). Materials and Methods A total of 909 elderly non‐metastatic NPC patients treated with cisplatin‐based CCRT or IC + CCRT between January 2007 and December 2016 were included. Prognostic nomograms were generated according to clinical characteristics and serum biomarkers. The survival outcomes of patients treated with CCRT versus IC + CCRT were compared in three well‐matched risk groups (high, medium, and low risk) after PSM analysis. Benefit of IC in people older or younger than 70 years and effect of different IC regimens and cycles on prognosis were analyzed. Results Nomograms of overall survival (OS) (C‐index: 0.64, 95% CI, 0.61–0.89) and disease special survival (DSS) (C‐index: 0.65, 95% CI, 0.62–0.71) showed good prognostic accuracy. The nomogram for DSS included variables of age, gender, ACE, EBV DNA, N stage, and T stage. OS included variables of age, smoking history, ACE, ALB, EBV DNA, N stage, and T stage. The corresponding 5‐year OS rates of high, medium and low risk groups were 87.4%, 82.2%, and 60.9%, respectively (p < 0.001), while the 5‐year DSS rates were 92.2%, 84.3%, and 69.0%, respectively (p < 0.001). In the high risk group, IC + CCRT led to significantly higher 5‐year OS and DSS rate compared with CCRT (5‐year OS rate, 73.5% versus 51.8%, p = 0.006; 5‐year DSS rate, 81.4% versus 61.3%, p = 0.002). While in the medium and low risk groups, OS and DSS were not significantly different (OS: p = 0.259, 0.186; DSS: p = 0.29, 0.094). Subgroup analysis showed in the high risk group, only people younger than 70 years old could benefit from IC. TPF and IC cycles of three could lead to the best survival results. Conclusion Compared with CCRT, OS, and DSS among high risk elderly patients were significantly improved by the addition of IC in patients younger than 70 years old. TPF and three IC cycles were recommended.

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Objective This study aimed to find a safe and effective cumulative cisplatin dose (CCD) for concurrent chemoradiotherapy (CCRT) beneficiaries among elderly nasopharyngeal carcinoma (NPC) patients. Materials and methods A total of 765 elderly (≥ 60 years old) NPC patients treated with cisplatin-based CCRT and IMRT-alone from 2007 to 2018 were included in this study. RPA-generated risk stratification was used to identify CCRT beneficiaries. CCDs were divided into CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m2 and their OS and nephrotoxicity compared. Results Pre-treatment plasma EBV DNA and clinical Stage were incorporated into the RPA model to perform risk stratification. All patients were classified into either a high-risk group (n = 158, Stage IV), an intermediate-risk group (n = 193, EBV DNA > 2000 copy/mL & Stage I, II, III) or a low-risk group (n = 414, EBV DNA ≤ 2000 copy/mL & Stage I, II, III). The 5-yearOS of CCRT vs. IMRT alone in the high-, intermediate- and low-risk groups after balancing covariate bias were 60.1% vs 46.6% (p = 0.02), 77.8% vs 64.6% (p = 0.03) and 86.2% vs 85.0% (p = 0.81), respectively. The 5-year OS of patients receiving CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m2 after balancing covariate bias in the high-risk group were 45.2%, 48.9%, 73.4% and 58.3% (p = 0.029), in the intermediate-risk group they were 64.6%, 65.2%, 76.8% and 83.6% (p = 0.038), and in the low-risk group they were 85.0%, 68.1%, 84.8% and 94.0% (p = 0.029), respectively. In the low-risk group, the 5-year OS of Stage III patients receiving CCD = 0, 0 < CCD ≤ 80, 80 < CCD ≤ 160 and 160 < CCD ≤ 300 mg/m2 were 83.5%, 76.9%, 85.5% and 95.5% (p = 0.044), respectively. No Grade 3–4 nephrotoxicity occurred. Conclusions In our study, Stage I, II & EBV DNA > 2000copy/ml and Stage III, IV elderly NPC patients may be CCRT beneficiaries. 80 < CCD ≤ 300 mg/m2 is recommended for the high-risk (Stage IV) group, and 160 < CCD ≤ 300 mg/m2 for the intermediate-risk (Stage I, II, III & EBV DNA > 2000copy/ml) and low-risk (Stage III&EBV DNA ≤ 2000 copy/ml) groups. No Grade 3–4 nephrotoxicity occurred in any of the CCD groups.