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    Practice patterns and outcomes of chemoradiotherapy versus radiotherapy alone for older patients with nasopharyngeal cancer

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    Author
    Verma, V.
    Surkar, S.M.
    Moreno, A.C.
    Date
    2018
    Journal
    Cancer Medicine
    Publisher
    Blackwell Publishing Ltd
    Type
    Article
    
    Metadata
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    See at
    https://dx.doi.org/10.1002/cam4.1290
    Abstract
    lder patients are at increased risk of toxicities from aggressive oncologic therapy and of nononcologic death. A meta‐analysis of non‐nasopharyngeal head and neck cancers showed no statistical benefit in adding chemotherapy to radiotherapy (RT) in older patients; another meta‐analysis of RT versus chemoradiotherapy (CRT) in NPC found advantages to CRT, but vastly under‐represented patients ≥70 years old. This is the largest study to date evaluating outcomes of CRT versus RT alone in this population. The National Cancer Data Base (NCDB) was queried for primary nasopharyngeal cancer cases (2004–2013) in patients ≥70 years old receiving RT alone or CRT. Patients with unknown RT/chemotherapy and T1N0 or M1 disease were excluded. Logistic regression analysis ascertained factors associated with CRT delivery. Kaplan–Meier analysis evaluated overall survival (OS) between both cohorts. Cox proportional hazards modeling determined variables associated with OS. In total, 930 patients were analyzed (n = 713 (77%) CRT, n = 217 (23%) RT). Groups were relatively balanced; CRT was less frequently delivered in patients with advancing age, lower nodal burden, and females (P < 0.05 for all). Median OS in the CRT and RT groups were 35.3 versus 20.0 months, respectively (P = 0.002). On multivariate analysis, independent predictors of OS included age, comorbidities, income and insurance status, tumor grade, and stage (P < 0.05 for all). Notably, receipt of chemotherapy independently predicted for improved OS (P = 0.036). CRT, compared to RT alone, was independently associated with improved survival in NPC patients ≥70 years old. CRT appears to be a promising approach in this population, but treatment‐related toxicity risks should continue to be weighed against potential oncologic benefits. Copyright 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
    Keyword
    Chemotherapy
    elderly
    geriatric
    nasopharyngeal cancer
    nasopharynx
    radiation therapy
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85044672648&doi=10.1002%2fcam4.1290&partnerID=40&md5=7247d7dc9bc4673ae837854bcb85f1d0; http://hdl.handle.net/10713/9159
    ae974a485f413a2113503eed53cd6c53
    10.1002/cam4.1290
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