202例老年鼻咽癌放化疗疗效分析

目的 回顾分析初诊老年鼻咽癌的放、化疗结果、不良反应和预后因素。方法 2004—2007年共202例60岁以上的初诊老年鼻咽癌患者在本院接受根治性放疗或化疗,男165例、女37例,中位年龄65岁。AJCC第六版分期标准Ⅰ期1例、Ⅱ期25例、Ⅲ期120例、Ⅳ a或Ⅳ b期56例。所有患者放疗剂量≥66 Gy,72、3%(146例)局部进展期患者联合化疗。Cox 法多因素预后分析。结果 随访率为100%。5年局部控制率、区域淋巴结控制率、无远处转移生存率、无瘤生存率及总生存率分别为93%、94%、82%、74%及和67%。经多因素分析发现肿瘤T、N分期及年龄是影响总生存及无远处转移生存的预后因素(P=0、006、0、002、0、008及0、020、0、002、0、022)。严重的急性不良反应包括4级放射性皮炎1例(0、5%)、放射性黏膜炎2例(1、0%)、骨髓抑制5例(2、5%)。结论 老年鼻咽癌患者放化疗耐受性可,针对分期较晚及一般状态较好的60~74岁患者应采取积极的综合治疗。

Therapeutic effect of radiotherapy and chemotherapy in 202 elderly patients with nasopharyngeal carcinoma

Objective To retrospectively analyze the outcomes, adverse events, and prognostic factors in elderly patients initially diagnosed with nasopharyngeal carcinoma (NPC) who receive radiotherapy and chemotherapy. Methods From January 2004 to April 2007, 202 patients (over 60 years of age) initially diagnosed with NPC received radical radiotherapy or chemotherapy. These patients included 165 males (81.7%) and 37 females (18.3%), with a median age of 65 years (range 60—86 years). Of all patients, 1 had stage Ⅰ NPC, 25 had stage Ⅱ NPC, 120 had stage Ⅲ NPC, and 56 had stage Ⅳ_a/Ⅳ_b NPC, according to the AJCC staging system (6^th edition). All patients received a radiation dose of ≥66 Gy, and 146 patients (72.3%) with locally advanced NPC also received chemotherapy. The Cox model was used for multivariate analysis. Results The follow-up rate was 100%. The 5-year local control rate, regional lymph node control rate, distant metastasis-free survival (DMFS) rate, disease-free survival rate, and overall survival (OS) rate were 93%, 94%, 82%, 74%, and 67%, respectively. The multivariate analysis revealed that T stage, N stage, and age were prognostic factors for OS and DMFS (P=0.006, 0.002, and 0.008;P=0.020, 0.002, and 0.022). The severe acute toxicities included grade 4 radiation dermatitis (1 patient, 0.5%), grade 4 radiation mucositis (2 patients, 1.0%), and grade 4 bone marrow suppression (5 patients, 2.5%). Conclusions The elderly NPC patients can tolerate radiotherapy and chemotherapy well. Multimodality therapy should be adopted for the patients aged 60—74 years who have advanced-stage NPC and good general conditions.