Radiation therapy for locoregionally advanced nasopharyngeal carcinoma in elderly patients

Objective The aim of this study was to evaluate the treatment outcome and toxicities of radiation therapy alone for elderly patients with locoregionally advanced nasopharyngeal carcinoma (NPC). Methods Seventy-three patients of 70 years old or above treated at our institution between January 1995 and December 2008 for locoregionally advanced NPC (stage III-IVA) were reviewed and analyzed. All patients were treated in a uniform fashion using our institutional protocol with using conformal radiation therapy alone. Measured outcomes included 4-year overall survival (OS), tumor-specific survival (TSS), disease-free survival (DFS), local control (LC), regional relapse-free survival (RRFS), distant metastasis free survival (DMFS), as well as late toxicity. Results The median follow-up for all 73 patients at the time of this analysis was 45 months (range, 5-152 months). The 4-year OS, TSS, DFS, LC, RRFS, and DMFS were 51.0, 64.5, 54.7, 83.7, 80.6, and 63.5, respectively. Radiation therapy was well tolerated in this group of patients. Multivariate analyses revealed that clinical stage (P00.006) and comorbidities (P00.018) were significant prognosticators for OS, both N classification (P00.023) and comorbidities (P00.032) were significant prognosticators for DFS, N classification was the only independent prognostic factor for both TSS (P00.002) and DMFS (P00.004); and residual disease in the primary site was the only independent predictive factor for LC (P00.026). Conclusion Radiation therapy alone can achieve a reasonable local and regional control in NPC patients with advanced age; however, distant metastasis remained the dominant failure pattern of our series. The presence of comorbidities was an important negative prognostic factor for treatment outcome.