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Comparison of intensity-modulated radiation therapy alone vs. intensity-modulated radiation therapy combined with chemotherapy in elderly nasopharyngeal carcinoma patients (aged >65 years)

  • Jing-Lin Mi
  • Yi-Liang Meng
  • Hong-liang Wu
  • Yi-Lin Cao
  • Bin Zhang
  • Yu-Fei Pan
  • Yuan-Yuan Zhou
  • Jin-Fang Fan
  • Shu-Fang Liao
  • Xiao-Li Qin
  • Da-Cheng Yao
  • Wei JiangEmail author
Original Article
  • 31 Downloads

Abstract

Purpose

The efficacy and tolerability of adding chemotherapy to radiotherapy in the era of intensity-modulated radiation therapy (IMRT) remain controversial among older patients with nasopharyngeal carcinoma (NPC). The present study compared IMRT alone with IMRT in combination with chemotherapy in elderly NPC patients.

Methods

Between January 2011 and December 2014, 102 patients aged >65 years with NPC who received IMRT alone (IMRT group) or IMRT in combination with chemotherapy (IMRT/CT group) were enrolled. Patients from both treatment arms were pair-matched (1:1 ratio) based on six clinical factors. Differences in overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) were assessed using the Kaplan–Meier method and Cox proportional hazards models, whereas the toxicity profile was assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 4.

Results

No significant differences were noted in OS (72.1% vs. 72.5%, p = 0.799), DFS (65.9% vs. 70.1%, p = 0.733), LRRFS (76.4% vs. 71.6%, p = 0.184), and DMFS (90.8% vs. 98.0%, p = 0.610) between the IMRT and IMRT/CT groups. Multivariate analyses showed that chemotherapy was not an independent factor for OS, DFS, LRRFS, and DMFS. However, the incidences of grade 3 vomiting/nausea (p = 0.000), leukopenia/neutropenia (p = 0.000), thrombocytopenia (p = 0.041), and anemia (p = 0.040) were significantly higher in the IMRT/CT group compared with the IMRT group. No grade 4 toxicities were observed.

Conclusion

IMRT alone was similar to IMRT/CT in treating elderly NPC patients (age >65 years), with comparable survival outcomes and less grade 3 toxicities.

Keywords

Intensity-modulated radiation therapy Chemotherapy Elderly patients Nasopharyngeal carcinoma Age > 65 years 

Vergleich zwischen intensitätsmodulierter Strahlentherapie allein und intensitätsmodulierter Strahlentherapie in Kombination mit Chemotherapie bei älteren Patienten (über 65 Jahre) mit Nasopharynxkarzinom

Zusammenfassung

Zielsetzung

Die Wirksamkeit und Verträglichkeit einer zusätzlich zur Strahlentherapie durchgeführten Chemotherapie in einer Zeit intensitätsmodulierter Radiotherapie (IMRT) bleibt bei älteren Patienten mit Nasopharynxkarzinom (NPC) umstritten. Die vorliegende Studie verglich IMRT allein mit IMRT in Kombination mit einer Chemotherapie bei älteren NPC-Patienten.

Methoden

Zwischen Januar 2011 und Dezember 2014 wurden 102 über 65 Jahre alte NPC-Patienten, die nur IMRT (IMRT-Gruppe) oder IMRT in Kombination mit Chemotherapie (IMRT/CT-Gruppe) erhielten, in die Studie einbezogen. Für die Patienten beider Therapiearme wurde die Matched-Pair-Bildung (Verhältnis 1:1), basierend auf sechs klinischen Faktoren, zugrundegelegt. Unterschiede im Gesamtüberleben (OS), im krankheitsfreien Überleben (DFS), im lokoregionären rückfallfreien Überleben (LRRFS) und im fernmetastasenfreien Überleben (DMFS) wurden mit der Kaplan-Meier-Methode und den Cox-proportionalen Gefahrenmodellen bewertet, während das Toxizitätsprofil mit Hilfe von CTCAE-Kriterien (Common Terminology Criteria for Adverse Events) Version 4 bewertet wurde.

Ergebnisse

Es wurden keine signifikanten Unterschiede im OS (72,1 % vs. 72,5 %; p = 0,799), DFS (65,9 % vs. 70,1 %; p = 0,733), LRRFS (76,4 % vs.71,6 %; p = 0,184) und DMFS (90,8 % vs. 98,0 %; p = 0,610) zwischen den IMRT- und IMRT/CT-Gruppen festgestellt. Multivariate Analysen zeigten, dass die Chemotherapie kein unabhängiger Faktor für OS, DFS, LRRFS und DMFS war. Die Häufigkeit von Grad-3-Erbrechen/Übelkeit (p = 0,000), Leukopenie/Neutropenie (p = 0,000), Thrombozytopenie (p = 0,041) und Anämie (p = 0,040) war allerdings in der IMRT/CT-Gruppe im Vergleich zur IMRT-Gruppe jeweils signifikant höher. Es wurden keine Grad-4-Toxizitäten beobachtet.

Schlussfolgerung

Die Behandlung älterer NPC-Patienten (über 65 Jahre) war mit IMRT allein ähnlich wie mit IMRT/CT, mit vergleichbaren Überlebensergebnissen und weniger Grad-3-Toxizitäten.

Schlüsselwörter

Intensitätsmodulierte Strahlentherapie Chemotherapie Ältere Patienten Nasopharynxkarzinom Alter > 65 Jahre 

Notes

Author Contribution

Jing-Lin Mi, Yi-Liang Meng, Hong-liang Wu and Yi-Lin Cao contributed equally to this work.

Funding

This work was supported by the National Natural Science Foundation of China (grant numbers 81560443, 81760546) and the Scientific Research and Technology Development Program of Guilin, China (grant number 20170109-22).

Conflict of interest

J.-L. Mi, Y.-L. Meng, H.-l. Wu, Y.-L. Cao, B. Zhang, Y.-F. Pan, Y.-Y. Zhou, J.-F. Fan, S.-F. Liao, X.-L. Qin, D.-C. Yao, and W. Jiang declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jing-Lin Mi
    • 1
  • Yi-Liang Meng
    • 2
  • Hong-liang Wu
    • 3
  • Yi-Lin Cao
    • 4
  • Bin Zhang
    • 5
  • Yu-Fei Pan
    • 4
  • Yuan-Yuan Zhou
    • 6
  • Jin-Fang Fan
    • 1
  • Shu-Fang Liao
    • 1
  • Xiao-Li Qin
    • 1
  • Da-Cheng Yao
    • 1
  • Wei Jiang
    • 1
    Email author
  1. 1.Department of Radiation OncologyAffiliated Hospital of Guilin Medical UniversityGuilinChina
  2. 2.Department of OncologyBaise People HospitalBaiseChina
  3. 3.Department of Otolaryngology-Head and Neck SurgeryAffiliated Hospital of Guilin Medical UniversityGuilinChina
  4. 4.Department of OncologyNanxishan Hospital of Guangxi Zhuang Autonomous RegionGuilinChina
  5. 5.Department of Radiation OncologyWuzhou Red Cross HospitalWuzhouChina
  6. 6.Department of Radiation OncologyLiuzhou General HospitalLiuzhouChina

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