Should standard concurrent chemoradiotherapy remain the preferred treatment for elderly patients with locoregionally advanced nasopharyngeal carcinoma?

Abstract

Background: Elderly patients are underrepresented in clinical studies supporting platinum-based concurrent chemoradiotherapy (CCRT) as the standard therapy (ST) for locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Many such patients in real-world settings cannot tolerate CCRT and instead receive individualized therapy (IT). This study aimed to compare the efficacy and safety of ST versus IT in elderly NPC patients.

Methods: A retrospective analysis was conducted on 393 elderly (≥ 65 years) LA-NPC patients from two centers in China between January 2013 and December 2020. Patients were categorized into ST (platinum-based CCRT with or without induction/adjuvant therapy) or IT (radiotherapy alone, or concurrent radiotherapy with non-chemotherapy agents, with or without induction/adjuvant therapy) groups. Propensity score matching (PSM) generated 141 patient pairs. Survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards models. Toxicities were compared with chi-square or Fisher's exact tests.

Results: In the PSM cohort, no significant differences were observed between the ST and IT groups in overall survival, cancer-specific survival, progression-free survival, locoregional relapse-free survival, and distant metastasis-free survival (all P > 0.05). Multivariable analysis confirmed that treatment group (ST vs. IT) was not a significant predictor for any survival endpoint. In exploratory stratified analysis, radiotherapy alone was associated with inferior OS, CSS, and PFS, whereas radiotherapy combined with systemic therapy showed survival outcomes similar to those of ST. Additionally, compared with the ST group, the IT group had significantly lower rates of grade 3 or higher hematologic toxicities, including leukopenia (8.5% vs. 23.4%; P = 0.001) and neutropenia (12.3% vs. 20.6%; P = 0.013).

Conclusion: Standard CCRT was not associated with improved survival outcomes compared with individualized therapy in elderly patients with LA-NPC, while individualized therapy showed a more favorable safety profile. Exploratory stratified analysis further suggested that radiotherapy combined with systemic therapy may represent a more promising individualized therapy option.

Clinical trial number: Not applicable.

Keywords: Elderly patients; Individualized therapy; Nasopharyngeal carcinoma; Real-world study; Treatment efficacy and toxicity.