title: Feasibility and efficacy of chemoradiotherapy for elderly patients with locoregionally advanced nasopharyngeal carcinoma: results from a matched cohort analysis.
abstract: BACKGROUND
  To clarify the feasibility and efficacy of chemoradiotherapy (CRT) in elderly (age≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  From January 2000 to December 2006, 101 newly diagnosed elderly non-metastatic NPC patients (age≥65 years) who received cisplatin 3-weekly or weekly concurrent CRT with/without sequential chemotherapy were recruited. Each patient from the CRT group was matched to another patient treated with radiotherapy (RT) alone based on age, gender, pathological type, performance status, overall stage, stage method, Adult Comorbidity Evaluation-27 (ACE-27) score and RT technique, from the same institute and time period. We also recruited 101 young patients (age<65 years) as the referent group, which had been matched to the CRT group based on patient characteristics and treatment parameters. Treatment tolerability and toxicity were clarified, and treatment outcomes were calculated and compared among groups.
  
  
  RESULTS
  CRT was feasible in elderly NPC patients, while a concurrent regimen of weekly cisplatin was more tolerable. Grade≥3 acute toxicity in CRT group was similar with referent group, although it was significantly higher than the RT alone group (65.3% vs. 43.6%, P=0.002). Furthermore, patients with ACE-27 score≥2 in the CRT group had significantly higher severe acute toxicity and dose reduction. Survival was poorer in elderly patients than the referent group. Compared to RT alone, CRT significantly improved the 5-year overall survival (OS: 54.6% vs. 39.3%, P=0.009), cancer-specific survival (CSS: 56.6% vs. 42.7%, P=0.022), disease-free survival (DFS: 51.6% vs. 30.2%, P=0.028) and locoregional relapse-free survival (LRRFS: 78.4% vs. 52.2%, P=0.003), but not distant metastasis-free survival (DMFS: 69.6% vs. 63.6%, P=0.669). However, CRT did not significantly improve 5-year OS (43.6% vs. 27.3%, P=0.893) or CSS (43.6% vs. 34.1%, P=0.971) in elderly NPC patients with ACE-27 score≥2.
  
  
  CONCLUSIONS
  CRT is feasible and effective in elderly patients with locoregionally advanced NPC without severe comorbidities. CRT should be used under serious consideration and be further tested in elderly patients with severe comorbidities. As such, it is essential to perform a comprehensive evaluation of pretreatment comorbidity status for all elderly NPC patients.
authors.forename: Huai
authors.initials: H
authors.lastname: Liu
authors.forename: Qiu-Yan
authors.initials: QY
authors.lastname: Chen
authors.forename: Ling
authors.initials: L
authors.lastname: Guo
authors.forename: Lin-Quan
authors.initials: LQ
authors.lastname: Tang
authors.forename: Hao-Yuan
authors.initials: HY
authors.lastname: Mo
authors.forename: Zong-Liang
authors.initials: ZL
authors.lastname: Zhong
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Huang
authors.forename: Dong-Hua
authors.initials: DH
authors.lastname: Luo
authors.forename: Rui
authors.initials: R
authors.lastname: Sun
authors.forename: Xiang
authors.initials: X
authors.lastname: Guo
authors.forename: Ka-Jia
authors.initials: KJ
authors.lastname: Cao
authors.forename: Ming-Huang
authors.initials: MH
authors.lastname: Hong
authors.forename: Hai-Qiang
authors.initials: HQ
authors.lastname: Mai
mesh_terms: D000368:Aged; D002277:Carcinoma; D059248:Chemoradiotherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D012189:Retrospective Studies