Real-World Treatment Practice and Survival Outcomes in Elderly Patients With Nasopharyngeal Carcinoma

Elderly patients with nasopharyngeal carcinoma (NPC) generally experience inferior treatment outcomes compared to the younger population. Understanding the complex interplay among age, treatment modalities, and clinical outcomes is critical for developing evidence-based clinical guidelines for this demographic. This study aimed to evaluate treatment patterns, compliance, and clinical outcomes in elderly NPC patients within a real-world setting.

We retrospectively included elderly patients (≥65 years) with NPC who received radiotherapy between January 2015 and December 2022. The primary endpoints were progression-free survival (PFS) and overall survival (OS). Statistical analyses were performed using the chi-square test, Kaplan-Meier method with log-rank test, and Cox proportional hazards model.

A total of 95 patients were included. Forty-two patients (44.2%) received induction chemotherapy (IC) followed by concurrent chemoradiotherapy (CCRT), 22 patients (23.2%) received CCRT alone, and 31 patients (32.6%) underwent radiotherapy alone. The CCRT completion rates were comparable between the IC group (64.3%) and the non-IC group (68.2%) (p = 0.755). Notably, 91 patients (95.7%) completed the recommended course of radiotherapy. The 5-year PFS and OS rates were 54.9% and 66.2%, respectively. Multivariate analysis identified age, gender, Adult Comorbidity Evaluation-27 score, Epstein-Barr Virus-deoxyribonucleic acid status, and treatment modality as independent prognostic factors. The results of multivariate prognostic analysis also showed that patients who did not receive CCRT had worse PFS (p = 0.029) and OS (p = 0.005) compared to those who received CCRT. However, no significant differences in PFS (p = 0.274) and OS (p = 0.594) were observed between the IC+CCRT and CCRT alone groups.

Despite high adherence to recommended radiotherapy regimens, survival outcomes in elderly NPC patients remain suboptimal. Our findings indicate that CCRT significantly improves survival compared to radiotherapy alone. However, the addition of IC to CCRT did not confer a survival benefit over CCRT alone. These findings underscore the importance of individualized treatment planning and the necessity of considering the comprehensive health status of elderly NPC patients in clinical practice.