Acute Toxicities and Prognosis of Elderly Patients with Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy: Prediction with Nomogram

PURPOSE: To explore acute toxicities and prognosis of elderly NPC patients after IMRT; to identify predictors regarding age, chemotherapy, comorbidities, nutrition status, and psychological condition; and to establish a nomogram for the prediction of prognosis. PATIENTS AND METHODS: Elderly NPC patients were divided into three groups (age of 60–65, age of 66–70, and age over 70) and were retrospectively analyzed. The acute toxicities, prognosis, and potential predictors were analyzed. Then, a nomogram for PFS was established, and the performance of nomogram was compared with the performance of TNM system. RESULTS: A total of 214 elderly patients (214/1981, 10.8%) were involved. Patients of Stage III and IV accounted for 73.4%. The 3-year, 5-year PFS and OS were 77.9%, 66.3%, 79.3% and 66.8%, respectively. Elder patients had a worse prognosis (P=0.002). The main cause of death remained in recurrence and metastasis; few died from comorbidities, and some died from nutrition status and psychological condition. Age (HR=1.10, 95% CI=1.05–1.15, P<0.001), ALB level (HR=0.93, 95% CI=0.88–0.99, P=0.019), and T stage (HR=1.85, 95% CI=1.10–3.13, P=0.022) were critical for PFS, but chemotherapy or comorbidities were not. Acute toxicities were mainly at or under grade II. N stage (OR=2.50, 95% CI=1.28–4.88, P=0.007) and chemotherapy (OR=6.01, 95% CI=3.11–11.63, P<0.001) were risk factors for hematological toxicity; while age (OR=0.59, 95% CI=0.37–0.92, P=0.020) and chemotherapy (OR=225.14, 95% CI=61.91–818.64, P<0.001) influenced emesis; ALB (OR=1.11, 95% CI=1.04–1.19, P=0.002) affected mucositis. Comorbidities were not influential in acute toxicities. The nomogram for PFS (C-index=0.682, 95% CI=0.617–0.747) performed better than the TNM system (C-index=0.604, 95% CI=0.532–0.674, P<0.001). CONCLUSION: Elderly NPC patients sustained poor prognosis. The easily applied nomogram is hopeful to benefit the clinical decision-making.