{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:07:58Z","timestamp":1785402478720,"version":"3.56.0"},"reference-count":45,"publisher":"IMR Press","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical and Health Guidance Project of Xiamen City","award":["3502Z20244ZD1001"],"award-info":[{"award-number":["3502Z20244ZD1001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background: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.Methods:We retrospectively included elderly patients (\u226565 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.Results: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.Conclusion: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.<\/jats:p>","DOI":"10.31083\/bjhm56190","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:59:43Z","timestamp":1785398383000},"source":"Crossref","is-referenced-by-count":0,"title":["Real-World Treatment Practice and Survival Outcomes in Elderly Patients With Nasopharyngeal Carcinoma"],"prefix":"10.31083","volume":"87","author":[{"given":"Zhenzhen","family":"Lu","sequence":"first","affiliation":[{"name":"The Graduate School of Fujian Medical University, 350005 Fuzhou, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linfeng","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 361005 Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqing","family":"You","sequence":"additional","affiliation":[{"name":"The Graduate School of Fujian Medical University, 350005 Fuzhou, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifeng","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 361005 Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0556-2614","authenticated-orcid":true,"given":"Sangang","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Xiamen Cancer Center, Xiamen Key Laboratory of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 361005 Xiamen, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yimin","family":"Li","sequence":"additional","affiliation":[{"name":"The Graduate School of Fujian Medical University, 350005 Fuzhou, Fujian, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Liu Q, Wang H, Chen Z, Xiong J, Huang Y, Zhang S, et al. Global, regional, and national epidemiology of nasopharyngeal carcinoma in middle-aged and elderly patients from 1990 to 2021. Ageing Research Reviews. 2025; 104: 102613.","DOI":"10.1016\/j.arr.2024.102613"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Brody-Camp S, McCoul ED, Lefante JJ, Aslam R. Socioeconomic Status and Survival in Nasopharyngeal Carcinoma: A Population-Based Study. The Laryngoscope. 2021; 131: 2719\u20132723.","DOI":"10.1002\/lary.29702"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Sze HCK, Ng WT, Chan OSH, Shum TCY, Chan LLK, Lee AWM. Radical radiotherapy for nasopharyngeal carcinoma in elderly patients: the importance of co-morbidity assessment. Oral Oncology. 2012; 48: 162\u2013167.","DOI":"10.1016\/j.oraloncology.2011.08.019"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Kim J, Lee Y, Kim S, Park JC. Novel Therapeutic Development for Nasopharyngeal Carcinoma. Current Oncology. 2025; 32: 479.","DOI":"10.3390\/curroncol32090479"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Zhang Y, Yi JL, Huang XD, Xu GZ, Xiao JP, Li SY, et al. Inherently poor survival of elderly patients with nasopharyngeal carcinoma. Head & Neck. 2015; 37: 771\u2013776.","DOI":"10.1002\/hed.23497"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Rueda Dom\u00ednguez A, Cirauqui B, Garc\u00eda Casta\u00f1o A, Alvarez Cabellos R, Carral Maseda A, Castelo Fern\u00e1ndez B, et al. SEOM-TTCC clinical guideline for nasopharyngeal carcinoma (update 2025). Clinical & Translational Oncology. 2026; 28: 1151\u20131164.","DOI":"10.1007\/s12094-026-04252-5"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Bossi P, Chan AT, Licitra L, Trama A, Orlandi E, Hui EP, et al. Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up\u2020. Annals of Oncology. 2021; 32: 452\u2013465.","DOI":"10.1016\/j.annonc.2020.12.007"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Tang LL, Chen YP, Chen CB, Chen MY, Chen NY, Chen XZ, et al. The Chinese Society of Clinical Oncology (CSCO) clinical guidelines for the diagnosis and treatment of nasopharyngeal carcinoma. Cancer Communications. 2021; 41: 1195\u20131227.","DOI":"10.1002\/cac2.12218"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Wu SG, Liao XL, He ZY, Tang LY, Chen XT, Wang Y, et al. Demographic and clinicopathological characteristics of nasopharyngeal carcinoma and survival outcomes according to age at diagnosis: A population-based analysis. Oral Oncology. 2017; 73: 83\u201387.","DOI":"10.1016\/j.oraloncology.2017.08.006"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Gihbid A, Tawfiq N, Benchakroun N, Bouchbika Z, Sahraoui S, Bendahhou K, et al. Epidemiological, Clinicopathological and Prognosis Features of Moroccan Patients with Nasopharyngeal Carcinoma. Asian Pacific Journal of Cancer Prevention. 2023; 24: 1477\u20131486.","DOI":"10.31557\/APJCP.2023.24.5.1477"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Piccirillo JF. Importance of comorbidity in head and neck cancer. The Laryngoscope. 2000; 110: 593\u2013602.","DOI":"10.1097\/00005537-200004000-00011"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Pan JJ, Ng WT, Zong JF, Chan LLK, O'Sullivan B, Lin SJ, et al. Proposal for the 8th edition of the AJCC\/UICC staging system for nasopharyngeal cancer in the era of intensity-modulated radiotherapy. Cancer. 2016; 122: 546\u2013558.","DOI":"10.1002\/cncr.29795"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363: 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Lee AW, Ng WT, Pan JJ, Poh SS, Ahn YC, AlHussain H, et al. International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiotherapy and Oncology. 2018; 126: 25\u201336.","DOI":"10.1016\/j.radonc.2017.10.032"},{"key":"ref15","unstructured":"National Cancer Institute. Common Terminology Criteria for Adverse Events v5.0 (CTCAE). 2017. Available at: https:\/\/dctd.cancer.gov\/research\/ctep-trials\/for-sites\/adverse-events\/ctcae-v5-5x7.pdf (Accessed: 21 June 2025)."},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). International Journal of Radiation Oncology, Biology, Physics. 1995; 31: 1341\u20131346.","DOI":"10.1016\/0360-3016(95)00060-C"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Wei KR, Zheng RS, Zhang SW, Liang ZH, Li ZM, Chen WQ. Nasopharyngeal carcinoma incidence and mortality in China, 2013. Chinese Journal of Cancer. 2017; 36: 90.","DOI":"10.1186\/s40880-017-0257-9"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Liang Y, Chen KH, Yang J, Zhang J, Peng RR, Qu S, et al. Acute Toxicities and Prognosis of Elderly Patients with Nasopharyngeal Carcinoma After Intensity-Modulated Radiotherapy: Prediction with Nomogram. Cancer Management and Research. 2020; 12: 8821\u20138832.","DOI":"10.2147\/CMAR.S261717"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Huang Y, Chen W, Haque W, Verma V, Xing Y, Teh BS, et al. The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis. Cancer Medicine. 2018; 7: 1093\u20131101.","DOI":"10.1002\/cam4.1377"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Li T, Li F, Guo X, Hong C, Yu X, Wu B, et al. Anti-Epstein-Barr Virus BNLF2b for Mass Screening for Nasopharyngeal Cancer. The New England Journal of Medicine. 2023; 389: 808\u2013819.","DOI":"10.1056\/NEJMoa2301496"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Yildirim HC, Kupik GE, Mustafayev TZ, Berber T, Yavuz B, Cetinayak O, et al. A multicenter retrospective analysis of patients with nasopharyngeal carcinoma treated in IMRT era from a nonendemic population: Turkish Society for Radiation Oncology Head and Neck Cancer Group Study (TROD 01-001). Head & Neck. 2023; 45: 1194\u20131205.","DOI":"10.1002\/hed.27333"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Hoppe S, Rainfray M, Fonck M, Hoppenreys L, Blanc JF, Ceccaldi J, et al. Functional decline in older patients with cancer receiving first-line chemotherapy. Journal of Clinical Oncology. 2013; 31: 3877\u20133882.","DOI":"10.1200\/JCO.2012.47.7430"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Chan WL, Chow JCH, Xu ZY, Li J, Kwong WTG, Ng WT, et al. Management of Nasopharyngeal Carcinoma in Elderly Patients. Frontiers in Oncology. 2022; 12: 810690.","DOI":"10.3389\/fonc.2022.810690"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Cao C, Fang Y, Jiang F, Jin Q, Jin T, Huang S, et al. Concurrent chemotherapy for older patients with locoregionally advanced nasopharyngeal carcinoma: A randomized clinical trial. Journal of Geriatric Oncology. 2025; 16: 102246.","DOI":"10.1016\/j.jgo.2025.102246"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Huang PY, Chen XY, Ding X, Guo L, Mo HY, Zou X, et al. Induction versus Concurrent Chemotherapy for Advanced Nasopharyngeal Carcinoma. NEJM Evidence. 2025; 4: EVIDoa2400214.","DOI":"10.1056\/EVIDoa2400214"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Yao JJ, Jin YN, Wang SY, Zhang F, Zhou GQ, Zhang WJ, et al. The detrimental effects of radiotherapy interruption on local control after concurrent chemoradiotherapy for advanced T-stage nasopharyngeal carcinoma: an observational, prospective analysis. BMC Cancer. 2018; 18: 740.","DOI":"10.1186\/s12885-018-4495-2"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Lin YH, Chang KP, Lin YS, Chang TS. Evaluation of effect of body mass index and weight loss on survival of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Radiation Oncology. 2015; 10: 136.","DOI":"10.1186\/s13014-015-0443-3"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Mi JL, Meng YL, Wu HL, Cao YL, Zhang B, Pan YF, et al. Comparison of intensity-modulated radiation therapy alone vs. intensity-modulated radiation therapy combined with chemotherapy in elderly nasopharyngeal carcinoma patients (aged >65 years). Strahlentherapie Und Onkologie. 2020; 196: 270\u2013279.","DOI":"10.1007\/s00066-019-01533-7"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Lyu Y, Ni M, Zhai R, Kong F, Du C, Hu C, et al. Clinical characteristics and prognosis of elderly nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. European Archives of Oto-Rhino-Laryngology. 2021; 278: 2549\u20132557.","DOI":"10.1007\/s00405-020-06399-5"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Kou J, Zhang LL, Yang XL, Wen DW, Zhou GQ, Wu CF, et al. Development of a Nomogram Model for Treatment of Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma. Journal of Personalized Medicine. 2021; 11: 1065.","DOI":"10.3390\/jpm11111065"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Li Y, Weng Y, Huang Z, Pan Y, Cai S, Ding Q, et al. Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification. Radiation Oncology. 2023; 18: 104.","DOI":"10.1186\/s13014-023-02272-x"},{"key":"ref32","doi-asserted-by":"publisher","unstructured":"Wu YL, He S, He D, Gao Y, Huang Y, Jing J. Optimizing the cumulative cisplatin dose for concurrent chemoradiotherapy beneficiaries among elderly nasopharyngeal carcinoma patients: a real world study. Scientific Reports. 2024; 14: 30652.","DOI":"10.1038\/s41598-024-69811-8"},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Li WZ, Lv SH, Liu GY, Liang H, Xia WX, Xiang YQ. Age-dependent changes of gender disparities in nasopharyngeal carcinoma survival. Biology of Sex Differences. 2021; 12: 18.","DOI":"10.1186\/s13293-021-00361-8"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Cui L, Chen Z, Zeng F, Jiang X, Han X, Yuan X, et al. Impact of sex on treatment-related adverse effects and prognosis in nasopharyngeal carcinoma. BMC Cancer. 2023; 23: 1146.","DOI":"10.1186\/s12885-023-11564-0"},{"key":"ref35","doi-asserted-by":"publisher","unstructured":"Lu T, Xiong X, Zhong F, Gong X, Li J. Intensity modulated radiation therapy in elderly patients with nasopharyngeal carcinoma. Holistic Integrative Oncology. 2023; 2: 20.","DOI":"10.1007\/s44178-023-00047-8"},{"key":"ref36","doi-asserted-by":"publisher","unstructured":"Wang F, Zhou L, Zhang LJ, Xie CB, Liao ZW, Lin XD, et al. Concurrent chemoradiotherapy versus radiotherapy alone in older patients with stage II nasopharyngeal carcinoma after intensity-modulated radiotherapy: A propensity score-matched cohort study. Radiotherapy and Oncology. 2024; 191: 110081.","DOI":"10.1016\/j.radonc.2024.110081"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Miao J, Wang L, Zhu M, Xiao W, Wu H, Di M, et al. Long-term survival and late toxicities of elderly nasopharyngeal carcinoma (NPC) patients treated by high-total- and fractionated-dose simultaneous modulated accelerated radiotherapy with or without chemotherapy. Oral Oncology. 2019; 89: 40\u201347.","DOI":"10.1016\/j.oraloncology.2018.12.008"},{"key":"ref38","doi-asserted-by":"publisher","unstructured":"Wu YL, Yang KB, Huang Y, Shi JR, He QS, Chen L, et al. Selection and validation of chemotherapy beneficiaries among elderly nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiation therapy (IMRT): a large real-world study. Radiation Oncology. 2022; 17: 138.","DOI":"10.1186\/s13014-022-02095-2"},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Chen L, Li K, Li Q, Ji P, Huang C, Tang L. Induction plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy in elderly patients with locoregionally advanced nasopharyngeal carcinoma. Radiotherapy and Oncology. 2024; 200: 110497.","DOI":"10.1016\/j.radonc.2024.110497"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Sun Y, Li WF, Chen NY, Zhang N, Hu GQ, Xie FY, et al. Induction chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locoregionally advanced nasopharyngeal carcinoma: a phase 3, multicentre, randomised controlled trial. The Lancet. Oncology. 2016; 17: 1509\u20131520.","DOI":"10.1016\/S1470-2045(16)30410-7"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Zhang Y, Chen L, Hu GQ, Zhang N, Zhu XD, Yang KY, et al. Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma. The New England Journal of Medicine. 2019; 381: 1124\u20131135.","DOI":"10.1056\/NEJMoa1905287"},{"key":"ref42","doi-asserted-by":"publisher","unstructured":"Lv X, Cao X, Xia WX, Liu KY, Qiang MY, Guo L, et al. Induction chemotherapy with lobaplatin and fluorouracil versus cisplatin and fluorouracil followed by chemoradiotherapy in patients with stage III-IVB nasopharyngeal carcinoma: an open-label, non-inferiority, randomised, controlled, phase 3 trial. The Lancet. Oncology. 2021; 22: 716\u2013726.","DOI":"10.1016\/S1470-2045(21)00075-9"},{"key":"ref43","doi-asserted-by":"publisher","unstructured":"Yu YF, Zhou P, Zhou R, Lin Q, Wu SG. Lobaplatin-based concurrent chemoradiotherapy in elderly nasopharyngeal carcinoma. Annals of Medicine. 2024; 56: 2383959.","DOI":"10.1080\/07853890.2024.2383959"},{"key":"ref44","doi-asserted-by":"publisher","unstructured":"Cao C, Fang Y, Jiang F, Jin Q, Jin T, Huang S, et al. Concurrent nimotuzumab and intensity-modulated radiotherapy for elderly patients with locally advanced nasopharyngeal carcinoma. Cancer Science. 2024; 115: 2729\u20132737.","DOI":"10.1111\/cas.16213"},{"key":"ref45","doi-asserted-by":"publisher","unstructured":"DIAMOND Study Group, Xu C, Liang XY, Huang XQ, Jin F, Yang KY, et al. Toripalimab Combination Therapy Without Concurrent Cisplatin for Nasopharyngeal Carcinoma: The DIAMOND Randomized Clinical Trial. JAMA. 2025; 334: 973\u2013983.","DOI":"10.1001\/jama.2025.13205"}],"container-title":["British Journal of Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/7\/10.31083\/BJHM56190","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T08:00:08Z","timestamp":1785398408000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.imrpress.com\/journal\/BJHM\/87\/7\/10.31083\/BJHM56190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":45,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"alternative-id":["S1750-8460(26)03317-0"],"URL":"https:\/\/doi.org\/10.31083\/bjhm56190","relation":{},"ISSN":["1750-8460","1759-7390"],"issn-type":[{"value":"1750-8460","type":"print"},{"value":"1759-7390","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"56190"}}