Management of Nasopharyngeal Carcinoma in Elderly Patients

Overview

Journal Front Oncol

Specialty Oncology

Date 2022 Feb 18

PMID 35178346

Authors

Wing Lok Chan

James Chung Hang Chow

Zhi-Yuan Xu

Jishi Li

Wing Tung Gobby Kwong

Wai Tong Ng

Anne W M Lee

Affiliations

Soon will be listed here.

Abstract

Nasopharyngeal cancer (NPC) is one of the most difficult cancers in the head and neck region due to the complex geometry of the tumour and the surrounding critical organs. High-dose radical radiotherapy with or without concurrent platinum-based chemotherapy is the primary treatment modality. Around 10%-15% of NPC patients have their diagnosis at age after 70. The management of NPC in elderly patients is particularly challenging as they encompass a broad range of patient phenotypes and are often prone to treatment-related toxicities. Chronologic age alone is insufficient to decide on the management plan. Comprehensive geriatric assessment with evaluation on patients' functional status, mental condition, estimated life expectancy, comorbidities, risks and benefits of the treatment, patients' preference, and family support is essential. In addition, little data from randomized controlled trials are available to guide treatment decisions in elderly patients with NPC. In deciding which treatment strategy would be suitable for an individual elderly patient, we reviewed the literature and reviewed the analysis of primary studies, reviews, and guidelines on management of NPC. This review also summarises the current evidence for NPC management in elderly adults from early to late stage of disease.

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References

Ng W, Ngan R, Kwong D, Tung S, Yuen K, Kam M . Prospective, Multicenter, Phase 2 Trial of Induction Chemotherapy Followed by Bio-Chemoradiotherapy for Locally Advanced Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys. 2018; 100(3):630-638. DOI: 10.1016/j.ijrobp.2017.11.038. View

Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen M, Extermann M . International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014; 32(24):2595-603. PMC: 4876338. DOI: 10.1200/JCO.2013.54.8347. View

Zhang Y, Yi J, Huang X, Xu G, Xiao J, Li S . Inherently poor survival of elderly patients with nasopharyngeal carcinoma. Head Neck. 2013; 37(6):771-6. DOI: 10.1002/hed.23497. View

Hsu C, Lee S, Ejadi S, Even C, Cohen R, Le Tourneau C . Safety and Antitumor Activity of Pembrolizumab in Patients With Programmed Death-Ligand 1-Positive Nasopharyngeal Carcinoma: Results of the KEYNOTE-028 Study. J Clin Oncol. 2017; 35(36):4050-4056. DOI: 10.1200/JCO.2017.73.3675. View

Hassett M, Rao S, Brozovic S, Stahl J, Schwartz J, Maloney B . Chemotherapy-related hospitalization among community cancer center patients. Oncologist. 2011; 16(3):378-87. PMC: 3228109. DOI: 10.1634/theoncologist.2010-0354. View

Mohile S, Dale W, Somerfield M, Hurria A . Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology Summary. J Oncol Pract. 2018; 14(7):442-446. PMC: 6041128. DOI: 10.1200/JOP.18.00180. View

Lin J, Wen C, Jiang C, Yuan J, Chen C, Ho S . Smoking and nasopharyngeal cancer: individual data meta-analysis of six prospective studies on 334 935 men. Int J Epidemiol. 2021; 50(3):975-986. PMC: 8271191. DOI: 10.1093/ije/dyab060. View

Chan O, Sze H, Lee M, Chan L, Chang A, Lee S . Reirradiation with intensity-modulated radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma. Head Neck. 2016; 39(3):533-540. DOI: 10.1002/hed.24645. View

Fee Jr W, Moir M, Choi E, Goffinet D . Nasopharyngectomy for recurrent nasopharyngeal cancer: a 2- to 17-year follow-up. Arch Otolaryngol Head Neck Surg. 2002; 128(3):280-4. DOI: 10.1001/archotol.128.3.280. View

10.

Zeng Q, Xiang Y, Wu P, Lv X, Qian C, Guo X . A matched cohort study of standard chemo-radiotherapy versus radiotherapy alone in elderly nasopharyngeal carcinoma patients. PLoS One. 2015; 10(3):e0119593. PMC: 4359128. DOI: 10.1371/journal.pone.0119593. View

11.

Lee A, Ng W, Chan L, Hung W, Chan C, Sze H . Evolution of treatment for nasopharyngeal cancer--success and setback in the intensity-modulated radiotherapy era. Radiother Oncol. 2014; 110(3):377-84. DOI: 10.1016/j.radonc.2014.02.003. View

12.

Zhang L, Zhang Y, Huang P, Xu F, Peng P, Guan Z . Phase II clinical study of gemcitabine in the treatment of patients with advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother Pharmacol. 2007; 61(1):33-8. DOI: 10.1007/s00280-007-0441-8. View

13.

Brugel L, Laurent M, Caillet P, Radenne A, Durand-Zaleski I, Martin M . Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer. 2014; 14:427. PMC: 4081503. DOI: 10.1186/1471-2407-14-427. View

14.

Sargent D, Goldberg R, JACOBSON S, Macdonald J, Labianca R, Haller D . A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med. 2001; 345(15):1091-7. DOI: 10.1056/NEJMoa010957. View

15.

Han F, Zhao C, Huang S, Lu L, Huang Y, Deng X . Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012; 24(8):569-76. DOI: 10.1016/j.clon.2011.11.010. View

16.

Chitapanarux I, Lorvidhaya V, Kamnerdsupaphon P, Sumitsawan Y, Tharavichitkul E, Sukthomya V . Chemoradiation comparing cisplatin versus carboplatin in locally advanced nasopharyngeal cancer: randomised, non-inferiority, open trial. Eur J Cancer. 2007; 43(9):1399-406. DOI: 10.1016/j.ejca.2007.03.022. View

17.

Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F . G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer. 2015; 15:875. PMC: 4640221. DOI: 10.1186/s12885-015-1800-1. View

18.

Zhang Y, Chen L, Hu G, Zhang N, Zhu X, Yang K . Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma. N Engl J Med. 2019; 381(12):1124-1135. DOI: 10.1056/NEJMoa1905287. View

19.

Muss H, Woolf S, Berry D, Cirrincione C, Weiss R, Budman D . Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 2005; 293(9):1073-81. DOI: 10.1001/jama.293.9.1073. View

20.

Guo R, Chen X, Chen L, Jiang F, Tang L, Mao Y . Comorbidity predicts poor prognosis in nasopharyngeal carcinoma: development and validation of a predictive score model. Radiother Oncol. 2015; 114(2):249-56. DOI: 10.1016/j.radonc.2014.12.002. View