Induction Chemotherapy plus Concurrent Chemoradiotherapy vs Concurrent Chemoradiotherapy in Elderly Patients with Advanced Nasopharyngeal Carcinoma

Objective This study aimed to compare survival and toxicity between induction chemotherapy followed by concurrent chemoradiotherapy (IC + CCRT) and concurrent chemoradiotherapy (CCRT) alone in elderly patients with advanced nasopharyngeal carcinoma (NPC). Study Design Propensity-matched analysis of survival and toxicity in a retrospective elderly cohort. Setting Department of Medical Oncology, Jingzhou Hospital, Tongji Medical College, Huazhong University of Science and Technology, China. Subjects and Methods In total, 193 patients with stage III to IVb NPC who were treated with IC + CCRT or CCRT alone were enrolled. A cohort with suitable propensity scores was created (82 patients in the IC + CCRT group and 82 patients in the CCRT group). Survival and toxicity were compared between the 2 groups. Results For the IC + CCRT group and the CCRT group, the 5-year locoregional failure-free survival (LRFFS) rate was 80.4% and 77.2% (P = .53), the 5-year distant failure-free survival (DFFS) rate was 80% and 76.9% (P = .517), the 5-year overall survival (OS) rate was 71.8% and 60.5% (P = .26), and the 5-year cancer-specific survival (CSS) rate was 75.3% and 66.7% (P = .144), respectively. There was a significant difference in the cumulative incidence of all grade 3 to 4 toxicities between the 2 groups (29.9% vs 17.7%, P = 4.8 x 10(-6)). Conclusions IC + CCRT had a high cumulative incidence of grade 3 to 4 toxicities in elderly patients with advanced NPC, while there were no improvements in 5-year LRFFS rate, DFFS rate, OS rate, or CSS rate between patients who underwent the IC + CCRT vs CCRT alone. Concurrent chemoradiotherapy alone is still the standard of treatment.