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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)

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

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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.

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.

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References

  1. Lee AW, Ma BB, Ng WT, Chan AT (2015) Management of Nasopharyngeal carcinoma: current practice and future perspective. J Clin Oncol 33(29):3356–3364. https://doi.org/10.1200/JCO.2015.60.9347

    Article  CAS  PubMed  Google Scholar 

  2. Tang LQ, Li CF, Li J, Chen WH, Chen QY, Yuan LX, Lai XP, He Y, Xu YX, Hu DP, Wen SH, Peng YT, Zhang L, Guo SS, Liu LT, Guo L, Wu YS, Luo DH, Huang PY, Mo HY, Xiang YQ, Sun R, Chen MY, Hua YJ, Lv X, Wang L, Zhao C, Cao KJ, Qian CN, Guo X, Zeng YX, Mai HQ, Zeng MS (2016) Establishment and validation of prognostic nomograms for endemic Nasopharyngeal carcinoma. JNCI J Natl Cancer Inst. https://doi.org/10.1093/jnci/djv291

    Article  PubMed  Google Scholar 

  3. Chua DT, Sham JS, Kwong DL, Au GK (2003) Treatment outcome after radiotherapy alone for patients with Stage I–II nasopharyngeal carcinoma. Cancer 98(1):74–80. https://doi.org/10.1002/cncr.11485

    Article  PubMed  Google Scholar 

  4. Xiao WW, Han F, Lu TX, Chen CY, Huang Y, Zhao C (2009) Treatment outcomes after radiotherapy alone for patients with early-stage nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 74(4):1070–1076. https://doi.org/10.1016/j.ijrobp.2008.09.008

    Article  PubMed  Google Scholar 

  5. Langendijk JA, Leemans CR, Buter J, Berkhof J, Slotman BJ (2004) The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature. J Clin Oncol 22(22):4604–4612. https://doi.org/10.1200/jco.2004.10.074

    Article  CAS  PubMed  Google Scholar 

  6. Zhang Y, Yi JL, Huang XD, Xu GZ, Xiao JP, Li SY, Luo JW, Zhang SP, Wang K, Qu Y, Gao L (2015) Inherently poor survival of elderly patients with nasopharyngeal carcinoma. Head Neck 37(6):771–776. https://doi.org/10.1002/hed.23497

    Article  PubMed  Google Scholar 

  7. Wang C, Tang X, Wang J, Song J, Xu Y (2017) Induction chemotherapy plus concurrent Chemoradiotherapy vs concurrent Chemoradiotherapy in elderly patients with advanced Nasopharyngeal carcinoma. Otolaryngol Head Neck Surg 157(2):233–238. https://doi.org/10.1177/0194599817699402

    Article  PubMed  Google Scholar 

  8. Cao C, Hu Q, Chen X (2018) Intensity-modulated radiotherapy for elderly patients with nasopharyngeal carcinoma. Head Neck 40(3):590–595. https://doi.org/10.1002/hed.25016

    Article  PubMed  Google Scholar 

  9. Zeng Q, Xiang YQ, Wu PH, Lv X, Qian CN, Guo X (2015) A matched cohort study of standard chemo-radiotherapy versus radiotherapy alone in elderly nasopharyngeal carcinoma patients. PLoS ONE 10(3):e119593. https://doi.org/10.1371/journal.pone.0119593

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Liu H, Chen QY, Guo L, Tang LQ, Mo HY, Zhong ZL, Huang PY, Luo DH, Sun R, Guo X, Cao KJ, Hong MH, Mai HQ (2013) Feasibility and efficacy of chemoradiotherapy for elderly patients with locoregionally advanced nasopharyngeal carcinoma: results from a matched cohort analysis. Radiat Oncol 8:70. https://doi.org/10.1186/1748-717x-8-70

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee AW, Lau WH, Tung SY, Chua DT, Chappell R, Xu L, Siu L, Sze WM, Leung TW, Sham JS, Ngan RK, Law SC, Yau TK, Au JS, O’Sullivan B, Pang ES, O SK, Au GK, Lau JT (2005) Preliminary results of a randomized study on therapeutic gain by concurrent chemotherapy for regionally-advanced nasopharyngeal carcinoma: NPC-9901 Trial by the Hong Kong Nasopharyngeal Cancer Study Group. J Clin Oncol 23(28):6966–6975. https://doi.org/10.1200/jco.2004.00.7542

    Article  CAS  PubMed  Google Scholar 

  12. Lin JC, Jan JS, Hsu CY, Liang WM, Jiang RS, Wang WY (2003) Phase III study of concurrent chemoradiotherapy versus radiotherapy alone for advanced nasopharyngeal carcinoma: positive effect on overall and progression-free survival. J Clin Oncol 21(4):631–637. https://doi.org/10.1200/jco.2003.06.158

    Article  PubMed  Google Scholar 

  13. Xu C, Zhang LH, Chen YP, Liu X, Zhou GQ, Lin AH, Sun Y, Ma J (2017) Chemoradiotherapy versus radiotherapy alone in stage II Nasopharyngeal carcinoma: a systemic review and meta-analysis of 2138 patients. J Cancer 8(2):287–297. https://doi.org/10.7150/jca.17317

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sun X, Su S, Chen C, Han F, Zhao C, Xiao W, Deng X, Huang S, Lin C, Lu T (2014) Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiother Oncol 110(3):398–403. https://doi.org/10.1016/j.radonc.2013.10.020

    Article  PubMed  Google Scholar 

  15. Lin S, Pan J, Han L, Guo Q, Hu C, Zong J, Zhang X, Lu JJ (2014) Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin. Radiother Oncol 110(3):385–389. https://doi.org/10.1016/j.radonc.2014.01.011

    Article  PubMed  Google Scholar 

  16. Mi JL, Zhang B, Pan YF, Su YX, Fan JF, Liao SF, Qin XL, Yao DC, Tang HY, Jiang W (2017) Chemotherapy regimens containing taxanes or fluorouracil in nasopharyngeal carcinoma: Which better? Oral Oncol 74:34–39. https://doi.org/10.1016/j.oraloncology.2017.09.003

    Article  CAS  PubMed  Google Scholar 

  17. Leu Y‑S, Chang Y‑F, Lee J‑C, Lo A‑C, Chen Y‑J, Chen H‑W (2014) Prognosis of Nasopharyngeal carcinoma in the elderly is worse than in younger individuals—experience of a medical institute. Int J Gerontol 8(2):81–84. https://doi.org/10.1016/j.ijge.2013.08.008

    Article  Google Scholar 

  18. Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S, Murthy V, Budrukkar A, Dinshaw K, Prabhash K, Chaturvedi P, D’Cruz A (2012) Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: a randomized controlled trial. Radiother Oncol 104(3):343–348. https://doi.org/10.1016/j.radonc.2012.07.001

    Article  CAS  PubMed  Google Scholar 

  19. Zhang B, Mo Z, Du W, Wang Y, Liu L, Wei Y (2015) Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis. Oral Oncol 51(11):1041–1046. https://doi.org/10.1016/j.oraloncology.2015.08.005

    Article  PubMed  Google Scholar 

  20. Al-Sarraf M, LeBlanc M, Giri PG, Fu KK, Cooper J, Vuong T, Forastiere AA, Adams G, Sakr WA, Schuller DE, Ensley JF (1998) Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol 16(4):1310–1317. https://doi.org/10.1200/jco.1998.16.4.1310

    Article  CAS  PubMed  Google Scholar 

  21. Wolden SL, Chen WC, Pfister DG, Kraus DH, Berry SL, Zelefsky MJ (2006) Intensity-modulated radiation therapy (IMRT) for nasopharynx cancer: update of the Memorial Sloan-Kettering experience. Int J Radiat Oncol Biol Phys 64(1):57–62. https://doi.org/10.1016/j.ijrobp.2005.03.057

    Article  PubMed  Google Scholar 

  22. Yi J, Huang X, Gao L, Luo J, Zhang S, Wang K, Qu Y, Xiao J, Xu G (2014) Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma. Radiat Oncol 9:56–56. https://doi.org/10.1186/1748-717X-9-56

    Article  PubMed  PubMed Central  Google Scholar 

  23. Su SF, Han F, Zhao C, Huang Y, Chen CY, Xiao WW, Li JX, Lu TX (2011) Treatment outcomes for different subgroups of nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy. Chin J Cancer 30(8):565–573. https://doi.org/10.5732/cjc.010.10547

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chan AT, Teo PM, Ngan RK, Leung TW, Lau WH, Zee B, Leung SF, Cheung FY, Yeo W, Yiu HH, Yu KH, Chiu KW, Chan DT, Mok T, Yuen KT, Mo F, Lai M, Kwan WH, Choi P, Johnson PJ (2002) Concurrent chemotherapy-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: progression-free survival analysis of a phase III randomized trial. J Clin Oncol 20(8):2038–2044. https://doi.org/10.1200/jco.2002.08.149

    Article  CAS  PubMed  Google Scholar 

  25. Chan AT, Leung SF, Ngan RK, Teo PM, Lau WH, Kwan WH, Hui EP, Yiu HY, Yeo W, Cheung FY, Yu KH, Chiu KW, Chan DT, Mok TS, Yau S, Yuen KT, Mo FK, Lai MM, Ma BB, Kam MK, Leung TW, Johnson PJ, Choi PH, Zee BC (2005) Overall survival after concurrent cisplatin-radiotherapy compared with radiotherapy alone in locoregionally advanced nasopharyngeal carcinoma. JNCI J Natl Cancer Inst 97(7):536–539. https://doi.org/10.1093/jnci/dji084

    Article  CAS  PubMed  Google Scholar 

  26. Zhang L, Zhao C, Peng PJ, Lu LX, Huang PY, Han F, Wu SX (2005) Phase III study comparing standard radiotherapy with or without weekly oxaliplatin in treatment of locoregionally advanced nasopharyngeal carcinoma: preliminary results. J Clin Oncol 23(33):8461–8468. https://doi.org/10.1200/jco.2004.00.3863

    Article  CAS  PubMed  Google Scholar 

  27. Lai SZ, Li WF, Chen L, Luo W, Chen YY, Liu LZ, Sun Y, Lin AH, Liu MZ, Ma J (2011) How does intensity-modulated radiotherapy versus conventional two-dimensional radiotherapy influence the treatment results in nasopharyngeal carcinoma patients? Int J Radiat Oncol Biol Phys 80(3):661–668. https://doi.org/10.1016/j.ijrobp.2010.03.024

    Article  PubMed  Google Scholar 

  28. Peng G, Wang T, Yang KY, Zhang S, Zhang T, Li Q, Han J, Wu G (2012) A prospective, randomized study comparing outcomes and toxicities of intensity-modulated radiotherapy vs. conventional two-dimensional radiotherapy for the treatment of nasopharyngeal carcinoma. Radiother Oncol 104(3):286–293. https://doi.org/10.1016/j.radonc.2012.08.013

    Article  PubMed  Google Scholar 

  29. Lee AW, Tung SY, Chua DT, Ngan RK, Chappell R, Tung R, Siu L, Ng WT, Sze WK, Au GK, Law SC, O’Sullivan B, Yau TK, Leung TW, Au JS, Sze WM, Choi CW, Fung KK, Lau JT, Lau WH (2010) Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma. JNCI J Natl Cancer Inst 102(15):1188–1198. https://doi.org/10.1093/jnci/djq258

    Article  PubMed  Google Scholar 

  30. Müller von der Grün J, Martin D, Stöver T, Ghanaati S, Rödel C, Balermpas P (2018) Chemoradiotherapy as Definitive Treatment for Elderly Patients with Head and Neck Cancer. Biomed Res Int 2018:3508795–3508795. https://doi.org/10.1155/2018/3508795

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Tan T, Lim WT, Fong KW, Cheah SL, Soong YL, Ang MK, Ng QS, Tan D, Ong WS, Tan SH, Yip C, Quah D, Soo KC, Wee J (2015) Concurrent chemo-radiation with or without induction gemcitabine, Carboplatin, and Paclitaxel: a randomized, phase 2/3 trial in locally advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 91(5):952–960. https://doi.org/10.1016/j.ijrobp.2015.01.002

    Article  PubMed  Google Scholar 

  32. Yu H, Gu D, He X, Gao X, Bian X (2016) The role of induction and adjuvant chemotherapy in combination with concurrent chemoradiotherapy for nasopharyngeal cancer: a Bayesian network meta-analysis of published randomized controlled trials. OTT 9:159–170. https://doi.org/10.2147/ott.s96983

    Article  CAS  Google Scholar 

  33. Chen L, Hu CS, Chen XZ, Hu GQ, Cheng ZB, Sun Y, Li WX, Chen YY, Xie FY, Liang SB, Chen Y, Xu TT, Li B, Long GX, Wang SY, Zheng BM, Guo Y, Sun Y, Mao YP, Tang LL, Chen YM, Liu MZ, Ma J (2012) Concurrent chemoradiotherapy plus adjuvant chemotherapy versus concurrent chemoradiotherapy alone in patients with locoregionally advanced nasopharyngeal carcinoma: a phase 3 multicentre randomised controlled trial. Lancet Oncol 13(2):163–171. https://doi.org/10.1016/s1470-2045(11)70320-5

    Article  PubMed  Google Scholar 

  34. Xu T, Shen C, Zhu G, Hu C (2015) Omission of chemotherapy in early stage Nasopharyngeal carcinoma treated with IMRT: a paired cohort study. Medicine 94(39):e1457. https://doi.org/10.1097/md.0000000000001457

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Hoppe S, Rainfray M, Fonck M, Hoppenreys L, Blanc JF, Ceccaldi J, Mertens C, Blanc-Bisson C, Imbert Y, Cany L, Vogt L, Dauba J, Houede N, Bellera CA, Floquet A, Fabry MN, Ravaud A, Chakiba C, Mathoulin-Pelissier S, Soubeyran P (2013) Functional decline in older patients with cancer receiving first-line chemotherapy. J Clin Oncol 31(31):3877–3882. https://doi.org/10.1200/jco.2012.47.7430

    Article  PubMed  Google Scholar 

  36. Vercelli M, Capocaccia R, Quaglia A, Casella C, Puppo A, Coebergh JW (2000) Relative survival in elderly European cancer patients: evidence for health care inequalities. The EUROCARE Working Group. Crit Rev Oncol Hematol 35(3):161–179

    Article  CAS  Google Scholar 

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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).

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Authors and Affiliations

  1. Department of Radiation Oncology, Affiliated Hospital of Guilin Medical University, 15 Lequn Road, 541001, Guilin, China

    Jing-Lin Mi, Jin-Fang Fan, Shu-Fang Liao, Xiao-Li Qin, Da-Cheng Yao &  Wei Jiang

  2. Department of Oncology, Baise People Hospital, 533000, Baise, China

    Yi-Liang Meng

  3. Department of Otolaryngology-Head and Neck Surgery, Affiliated Hospital of Guilin Medical University, 541001, Guilin, China

    Hong-liang Wu

  4. Department of Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, 541004, Guilin, China

    Yi-Lin Cao & Yu-Fei Pan

  5. Department of Radiation Oncology, Wuzhou Red Cross Hospital, 543002, Wuzhou, China

    Bin Zhang

  6. Department of Radiation Oncology, Liuzhou General Hospital, 545006, Liuzhou, China

    Yuan-Yuan Zhou

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  1. Jing-Lin Mi
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Correspondence to Wei Jiang.

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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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Mi, JL., Meng, YL., Wu, Hl. et al. Comparison of intensity-modulated radiation therapy alone vs. intensity-modulated radiation therapy combined with chemotherapy in elderly nasopharyngeal carcinoma patients (aged >65 years). Strahlenther Onkol 196, 270–279 (2020). https://doi.org/10.1007/s00066-019-01533-7

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