Induction Chemotherapy Followed by Radiotherapy versus Concurrent Chemoradiotherapy in elderly patients with nasopharyngeal carcinoma: finding from a propensity-matched analysis

Abstract

BackgroundTo date, no guideline is proposed for elderly nasopharyngeal carcinoma (NPC) due to lack of prospective clinical trials. The present study comparing the survivals and toxicities in elderly NPC patients received either induction chemotherapy followed by radiotherapy(IC + RT) or concurrent chemoradiotherapy (CCRT) was therefore undertaken to provide a more accurate basis for future clinical practice.MethodsThe eligible elderly NPC patients were retrospectively enrolled. Propensity score matching generated a matched cohort (1:2) composed from CCRT and IC + RT groups. The survivals and treatment-induced toxicities were compared between two groups. Multivariable analysis was carried to identify significant prognostic factors.ResultsThe 5-year overall survival, cancer-specific survival, locoregional failure-free survival, distant failure-free survival for all patients were 58.3 %, 62.7 %, 88.7 %, 83.0 %, respectively. No significant survival differences were found between CCRT and IC + RT groups in the propensity-matched cohort. In comparison with the patients who received IC + RT, patients who underwent CCRT were associated with more severe acute toxicities including leucopenia (30 % vs. 6.8 %, P = 0.005), anemia (20 % vs. 4.1 %, P = 0.027), mucositis (63.3 % vs. 34.2 %, P = 0.007), weight loss (23.4 % vs. 4.1 %, P = 0.009). Basicranial bone involvement was an independent prognostic factor that predicted all-cause death (HR = 0.553, 95 % CI 0.329–0.929; P = 0.025) and cancer specific death (HR = 0.558, 95 % CI 0.321–0.969; P = 0.038) in elderly patients.ConclusionsIn the context of no guideline for elderly NPC, the present study suggested IC + RT should be a preferable modality compared with CCRT, with similar treatment outcomes but less acute toxicities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2661-y) contains supplementary material, which is available to authorized users.

Impact of age on survival of locoregional nasopharyngeal carcinoma: An analysis of the Surveillance, Epidemiology, and End Results program database, 2004‐2013

“…Zeng et al, in a study of almost 500 patients aged 60 or older, found that older patients had more problems with treatment‐related toxicities after receiving concurrent chemoradiotherapy than they did after receiving induction chemotherapy followed by radiotherapy. However, they found no difference in risk of death (OS, CSS, LRFFS, or DFFS) among patients with less advanced (lower T stage, lower N stage) disease when compared to those with more advanced disease . The findings of our study should be confirmed by similar analyses of other large databases such as the National Cancer Database.…”

Managing an Older Adult with Cancer: Considerations for Radiation Oncologists

“…Older adults with poorer functional status may better tolerate sequential, rather than concurrent, chemoradiation [ 139 ]. One study found that patients with nasopharyngeal carcinoma receiving sequential chemoradiation had overall less severe acute toxicities (leukopenia, anemia, mucositis, and weight loss) than those who underwent concurrent chemoradiotherapy; however, there was no significant difference in survival between the two modalities [ 140 ]. The use of more precise radiation technologies, hypofractionation, and sequential chemoradiation may benefit older individuals with poor functional status.…”

Historical and Clinical Experiences of Gene Therapy for Solid Cancers in China

“…Chemo- and radio-therapy, recognized as traditional and classic forms of cancer treatment, ionize DNA or generate free radicals to induce DNA lesions, including single- and double-stranded breaks and base damage [46]. However, clinical results have shown that these two treatment strategies do not yield satisfactory results for patients, especially for solid tumors, which may explain the lack of significant improvements in the overall survival rate over the last 30 years [47].…”