J Cancer 2018; 9(17):3023-3031. doi:10.7150/jca.26145

Research Paper

Concurrent Chemoradiotherapy versus Intensity-modulated Radiotherapy Alone for Elderly Nasopharyngeal Carcinoma Patients with Pre-treatment Epstein-Barr Virus DNA: A Cohort Study in an Endemic Area with Long-term Follow-up

Qin Yang1,2, Ting-Ting Zhao3, Meng-Yun Qiang1,4, Liang Hu1,5, Xing Lv1,5, Yan-Fang Ye6, Liang-Ru Ke1,5, Ya-Hui Yu1,5, Wen-Ze Qiu1,5, Guo-Ying Liu1,5, Xin-Jun Huang1,5, Wang-Zhong Li1,5, Shu-Hui Lv1,5, Yao Sun7, Lu-Yao Zhang8, Fei Pei8, Xiang Guo1,5, Yan-Qun Xiang1,5, Chao-Nan Qian1,5✉, Bi-Jun Huang1✉, Wei-Xiong Xia1,5✉

1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.
2. Department of Gynecology Oncology, Shaanxi Provincial Cancer Hospital Affiliated to Medical School, Xi'an Jiaotong University, Xi'an, China.
3. Department of Oncology, Guiyang Hospital of Guizhou Aviation Industry Group, Guizhou, China.
4. Department of Radiotherapy, Sun Yat-Sen University Cancer Center, Guangzhou, China.
5. Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.
6. Clinical Trial Design Division, Clinical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
7. The Third Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China.
8. The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Guangzhou, China.

Abstract

Purpose: To date, no guidelines exist for elderly nasopharyngeal carcinoma (NPC) patients (60 years of age or older) due to a lack of prospective clinical trials. This study evaluated the efficacy of concurrent chemotherapy (CCRT) for NPC in elderly patients treated with intensity-modulated radiotherapy (IMRT).

Methods: Patients were identified from a prospectively maintained database. A total of 198 consecutive cases of elderly patients with NPC receiving IMRT, including 103 patients treated with IMRT plus CCRT and 95 patients treated with IMRT alone, were analysed from January 2002 to December 2013. Multivariate analysis (MVA) using the Cox proportional hazards model and propensity score analysis (PSA) were performed for overall survival (OS) and disease-free survival (DFS). Finally, sensitivity analysis was performed.

Results: The median follow-up time was 55.3 months (range, 3-135.6 months). In the entire cohort, both MVA and PSA models showed that compared with IMRT alone, IMRT plus CCRT significantly improved survival (hazard ratio [HR] 2.143, 95% confidence interval [95% CI] 1.180-3.890; HR 1.961, 95% CI, 1.117-3.443, for OS and DFS, respectively). Similar results were found in the subgroups with high levels of Epstein-Barr virus (EBV) DNA, except in the low-EBV-DNA cohort. The total rates of severe acute toxicity, including leukopenia, neutropenia, stomatitis, and emesis, were significantly higher in the IMRT+CCRT group than in the IMRT-alone group (P < 0.001) but were similar to the rates of severe late toxicity (P = 0.818). Sensitivity analysis confirmed the robustness of our analysis.

Conclusions: In the era of IMRT, CCRT retained survival benefits at high EBV DNA levels but not at low EBV DNA levels for elderly NPC patients. Randomized clinical trials are needed to confirm our findings.

Keywords: elderly nasopharyngeal carcinoma, concurrent chemotherapy, intensity-modulated radiotherapy, EBV DNA, propensity score analysis

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How to cite this article:
Yang Q, Zhao TT, Qiang MY, Hu L, Lv X, Ye YF, Ke LR, Yu YH, Qiu WZ, Liu GY, Huang XJ, Li WZ, Lv SH, Sun Y, Zhang LY, Pei F, Guo X, Xiang YQ, Qian CN, Huang BJ, Xia WX. Concurrent Chemoradiotherapy versus Intensity-modulated Radiotherapy Alone for Elderly Nasopharyngeal Carcinoma Patients with Pre-treatment Epstein-Barr Virus DNA: A Cohort Study in an Endemic Area with Long-term Follow-up. J Cancer 2018; 9(17):3023-3031. doi:10.7150/jca.26145. Available from http://www.jcancer.org/v09p3023.htm