Do elderly patients with locally advanced nasopharyngeal carcinoma benefit from radiotherapy combined with chemotherapy?

Abstract

Abstract Background: The study aims to clarify whether elderly patients with locally advanced nasopharyngeal carcinoma (LA-NPC) can benefit from radiotherapy combined with chemotherapy. Methods: The clinical variables of 441 patients aged ≥70 years old with no-metastasis NPC who underwent either radiotherapy or chemotherapy between 2000 and 2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The primary endpoint is overall survival (OS). The risk factors of different treatment mode were evaluated using Cox-regression analyses. The selected variables were used to construct the nomogram to evaluate the 1-year, 3-year, 5-year probability of OS. The discrimination and calibration of the nomogram were assessed using concordance index (C-index), area under curve (AUC), and calibration plots. We compare OS of different treatment mode using Kaplan-Meier method. Subgroup analysis of different age were explored. Results: Factors including marital status, chemotherapy and radiation use were associated with OS. Sex, histology, radiation, chemotherapy, race, marital status were used to the nomogram for predicting the probability of survival. The C-index of the nomogram was 0.725 (95% confidence interval [CI]: 0.695 - 0.756). AUC for 1- , 3- and 5-year were 0.769 ( 95% CI: 0.720 - 0.819), 0.747 ( 95% CI: 0.699 - 0.796) and 0.708 (95% CI: 0.650 - 0.766), respectively. Chemotherapy alone, radiotherapy alone and chemoradiotherapy offered a significant survival benefit in LA-NPC aged ≥70 years old (all p < 0.05). Notebly, subgroup analysis showed that patients over 75 years and 80 years old still benefit from chemoradiotherapy. ( p < 0.0001). Conclusions: Radiotherapy combined with chemotherapy has significant survival benefit in elderly LA-NPC patients aged ≥70 years old. Nevertheless, it requires careful comorbidity assessment and further clinical trials.