Therapeutic effect of radiotherapy and chemotherapy in 202 elderly patients with nasopharyngeal carcinoma

Objective: To retrospectively analyze the outcomes, adverse events, and prognostic factors in elderly patients initially diagnosed with nasopharyngeal carcinoma (NPC) who receive radiotherapy and chemotherapy. Methods: From January 2004 to April 2007, 202 patients (over 60 years of age) initially diagnosed with NPC received radical radiotherapy or chemotherapy. These patients included 165 males (81.7%) and 37 females (18.3%), with a median age of 65 years (range 60-86 years). Of all patients, 1 had stage I NPC, 25 had stage II NPC, 120 had stage III NPC, and 56 had stage IV_a/IV_b NPC, according to the AJCC staging system (6^th edition). All patients received a radiation dose of ≥ 66 Gy, and 146 patients (72.3%) with locally advanced NPC also received chemotherapy. The Cox model was used for multivariate analysis. Results: The follow-up rate was 100%. The 5-year local control rate, regional lymph node control rate, distant metastasis-free survival (DMFS) rate, disease-free survival rate, and overall survival (OS) rate were 93%, 94%, 82%, 74%, and 67%, respectively. The multivariate analysis revealed that T stage, N stage, and age were prognostic factors for OS and DMFS (P = 0.006, 0.002, and 0.008; P = 0.020, 0.002, and 0.022). The severe acute toxicities included grade 4 radiation dermatitis (1 patient, 0.5%), grade 4 radiation mucositis (2 patients, 1.0%), and grade 4 bone marrow suppression (5 patients, 2.5%). Conclusions: The elderly NPC patients can tolerate radiotherapy and chemotherapy well. Multimodality therapy should be adopted for the patients aged 60-74 years who have advanced-stage NPC and good general conditions. (authors)