Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis

Abstract

BackgroundTo analyse the outcome of elderly patients (≥70 years) with esophageal cancer treated with curative intent radio(chemo)therapy.MethodsFifty five patients (median 75 years) receiving curative intent radio(chemo)therapy for esophageal cancer from 1999 to 2015 were retrospectively analyzed. Most patients showed locally advanced disease (T3/4:78%, N+:58%) with squamous cell histology (74%). Charlson comorbidity score was > 1 in 27%. 48 patients (87%) received definitive treatment while 7 patients were treated neoadjuvantly. RT was carried out as 3D-conformal treatment or IMRT. Concurrent chemotherapy was applied in 85%, mainly cisplatin/5-FU or mitomycin/5-FU. 18FDG-PET/CT staging was used in 65%.ResultsMedian follow-up was 11 months (1–68) and 21 months in survivors. 1- and 2-year rates of LRC, DC, FFTF and OS were 60%/45, 81%/72, 55%/41 and 46%/26% for the entire cohort. In univariate analysis, addition of surgery was associated with improved LRC and FFTF, nodal involvement with improved DC and lower T stage, lower Charlson score and use of PET-CT with improved OS. In multivariate analysis, lower T stage and lower Charlson score remained significant for OS. Patients treated after 2008 showed a significantly improved FFTF (1-year FFTF 64% vs 35%) and OS (1-year OS 66% vs 24%). Maximum (chemo)radiation related grade3+ toxicity was observed in 80% including 7 deaths (13%). Grade5 toxicity was significantly associated with Charlson score (CS > 1:33% vs CS ≤ 1:5%) and treatment period (24% before vs 3% after 2008). The patients treated after 2008 included significantly more SCCs, less T4 stages, had a higher percentage of PET-CT staging and were treated with smaller field lengths. Trends were also observed for lower Charlson scores and increased use of IMRT.ConclusionCurative intent (chemo)radiation of elderly patients with esophageal cancer may result in considerable toxicity and unfavorable outcome. However, a clear improvement over time was observed in our cohort, probably based on improved patient selection. In patients with less advanced stages and lower comorbidity similar results as in younger cohorts seem achievable with modern staging and treatment approaches. Age per se should not be a decisive factor, but careful attention should be paid regarding patient selection including a structured and tight follow-up strategy.

Neoadjuvant and Definitive Radiochemotherapeutic Approaches in Esophageal Cancer: A Retrospective Evaluation of 122 Cases in Daily Clinical Routine

“…Thus, comparable end results in OS are very satisfying [6, 22]. Valid predictive criteria for therapeutic decisions are urgently needed as well as diagnostic modalities for determining residual disease after neoRCT has been performed [23]; patients can be spared the strain of possibly unnecessary surgery. A topic of particular interest in cases of operatively high-risk situations, e.g., comorbidities, advanced age, etc., is the watch-and-wait approach after RT/RCT due to surgery-associated risks [24, 25].…”

Prognostic significance of lung radiation dose in patients with esophageal cancer treated with neoadjuvant chemoradiotherapy

“…Neoadjuvant chemoradiotherapy (NCRT) has been suggested for improvement of complete resection rate and survival rate. The CROSS trial confirmed the benefit of NCRT among esophageal cancer patients amenable to surgery [6, 7]; hence, NCRT followed by surgery (trimodal therapy) has become the mainstay of treatment for esophageal cancer [6–11].…”

Gastrointestinale Tumoren beim älteren und alten Patienten

“…Daten für ein Kollektiv von älteren und alten Patienten liegen nicht vor. Bei der Auswahl der Patienten sollte jedoch sorgfältig vorgegangen werden, da sich in retrospektiven Analysen teils erhebliche Toxizität zeigte [25]. In anderen retrospektiven Analysen zeigte sich bei 1364 Patienten retrospektiv ein verbessertes Gesamtüberleben unter Trimodaler Therapie mit Radiochemotherapie und Operation (HR = 0,76, 95 %-KI [0,70-0,82], p ≤ 0,001).…”