Feasibility and Efficacy of Concurrent Chemoradiotherapy in Elderly Patients with Esophageal Squamous Cell Carcinoma: a Respective Study of 116 Cases from a Single Institution

Abstract

Background: To evaluate the safety and efficacy of combined chemoradiotherapy or radiotherapy alone in elderly patients with esophageal carcinoma to identify the best method of treatment. Materials and Methods: One hundred and sixteen patients with esophageal carcinoma aged 70 and older who received definitive radiotherapy or chemoradiotherapy entered the study. Overall survival (OS), disease-free survival (DFS) and treatmentrelated toxicities were assessed. Results: The median OS of the overall population was 17.9 months. For patients treated with cCRT, sCRT and radiotherapy alone, the median OS was 22.3 months, 18.0 months and 12.4 months respectively(P=0.044). Median OS for patients treated with radiotherapy dose ≥60Gy and <60Gy was 20.2 months and 10.9 months respectively (p=0.017). By univariate analysis, Chemoradiotherapy (include cCRT and sCRT) and radiotherapy dose ≥60Gy were found to achieve higher survival rates compared with radiotherapy alone and radiotherapy dose <60Gy (P=0.015, P=0.017). By multivariate analysis, chemoradiotherapy (HR=1.645, P=0.022) and radiotherapy dose ≥60Gy (HR=1.642, P=0.025) were identified as independent prognostic factors of OS. Conclusions: Definitive concurrent chemoradiotherapy could be considered as a feasible and effective treatment in esophageal carcinoma patients aged 70 and older. Radiotherapy dose 60Gy is an effective treatment option compared with standard dose radiotherapy, while higher doses are not beneficial to improve survival.

Feasibility and efficiency of concurrent chemoradiotherapy with a single agent or double agents vs radiotherapy alone for elderly patients with esophageal squamous cell carcinoma: Experience of two centers

“…Compared with patients treated with RT alone, patients who received CCRT had better survival outcomes (OS, 27.8 ± 2.4 vs 15.6 ± 1.9; PFS, 16.5 ± 1.9 vs 10.4 ± 0.9 months). Our results in elderly patients were consistent with those of previous studies, 15,17,18,24 but our study is the first to compare the efficacy of CCRT-1 and CCRT-2 in patients. However, the data failed to identify a statistically significant difference in median OS or median PFS.…”

“…13 The results of a phase II, single-arm study evaluating platinum-based chemotherapy combined with radiotherapy in patients older than 75 years with esophageal carcinoma suggested that chemotherapy is feasible and tolerable in elderly patients. 14 Meanwhile, there have been several retrospective studies [14][15][16][17][18][19][20][21][22][23][24] in elderly patients with OC had indicated that concurrent chemoradiation might be an optimal strategy for elderly patients with OC. Studies with more than 20 patients were listed in Table 6.…”

Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer

“…Meanwhile, the results from propensity score and meta-analysis both showed survival advantage of IMRT for EC patients compared with traditional RT technique, such as 3D conformal RT (3D-CRT) [17,18]. Furthermore, on the basis of IMRT, definitive RT dose ≥60 Gy has yielded more favorable survival outcomes compared with standard dose 50.4 Gy in some latest researches [19,20], and the similar effect could be found in the elderly population without increasing treatment-related toxicities [21]. In the present study, all of very elderly patients were experienced IMRT and gained good short-term clinical effect, moreover, the subgroup of PGTV dose ≥ 60 Gy had superior LRFFS and better trends for OS (univariate analysis P = 0.055), these results indicated that dose escalation for tumor probably improve OS by enhancing LRFFS in very elderly EC patients, which also need to be further verified in prospective clinical trials.…”

Does chemoradiotherapy benefit elderly patients with esophageal squamous cell cancer? A propensity-score matched analysis on multicenter data (3JECROG R-03A)

“…However, to date, the appropriate doses and schedules of chemotherapy for these patients are yet to be determined [19]. Several studies had proven that dual-agent therapy achieved superior survival than single-agent CRT for elderly patients with ESCC [20,21]. Zhao et al demonstrated that CRT with a single agent in elderly patients had a similar survival benefit compared to CRT with a dual agent, accompanied by less toxicity [22].…”