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

Huang, Chunyue; Zhu, Yujia; Li, Qiwen; Zhang, Wenwen; Liu, Hui; Zhang, Weijun; Hu, Yonghong; Yuan, Yawei; Liu, Mengzhong

doi:10.1002/cam4.1788

Cited by 18 publications

(18 citation statements)

References 27 publications

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“…Huang et al . reported that the rate of grade ≥3 toxicities was 25.5% among 271 elderly EC patients who received concurrent chemoradiotherapy ( 21 ). Zhao et al .…”

Section: Discussionmentioning

confidence: 99%

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Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients: A phase II clinical trial

Yang¹,

Zhai²,

Bi³

et al. 2021

Chinese Journal of Cancer Research

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Objective To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma (EC). Methods Eligible patients were aged 70 years or older and had treatment-naïve, histologically proven inoperable locally advanced EC. Enrolled patients received radiotherapy with a total dose of 50−60 Gy in 25−30 fractions, concurrent with weekly infusion of nimotuzumab. The primary end point was the rate of more than grade 3 toxicities. Results From June 2011 to July 2016, 46 patients with stage II−IV EC with a median age of 76.5 years were enrolled. There were 10, 28 and 8 patients with stage II, III and IV disease, respectively. The common acute toxicities included esophagitis (grade 1−2, 75.4%; grade 3, 8.7%), pneumonitis (grade 1, 4.3%; grade 2, 6.5%; grade 3, 2.2%), leukopenia (grade 1−2, 60.9%; grade 3−4, 4.4%), gastrointestinal reaction (grade 1−2, 17.3%; grade 3, 2.2%), thrombocytopenia (grade 1−2, 21.7%; grade 3, 2.2%), and radiothermitis (grade 1−2, 39.2%). The incidence of grade 3−4 adverse effects was 17.4%. No grade 5 toxicities were observed. Clinical complete response, partial response, stable disease, and progressive disease were observed in 1 (2.2%), 31 (67.4%), 12 (26.1%), and 2 (4.3%) patients, respectively. The median overall survival (OS) and progression-free survival (PFS) were 17 and 10 months, respectively. The 2-, 3-, and 5-year OS and PFS rates were 30.4%, 21.7%, 19.6%, and 26.1%, 19.6%, 19.6%, respectively. Conclusions Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates. Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

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“…Huang et al . reported that the rate of grade ≥3 toxicities was 25.5% among 271 elderly EC patients who received concurrent chemoradiotherapy ( 21 ). Zhao et al .…”

Section: Discussionmentioning

confidence: 99%

“…Huang et al . reported an MST of 23.6 months and a median PFS of 13.6 months among 271 elderly patients ( 21 ). Zhao et al .…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients: A phase II clinical trial

Yang¹,

Zhai²,

Bi³

et al. 2021

Chinese Journal of Cancer Research

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“…RT alone should be recommended with caution even in the eldest group (aged > 85 years). If patients cannot tolerate doublet CT combined with RT, single-drug oral CT drugs can be considered, such as S1, Xeloda, and other uorouracil analogues [12,35].…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns and Outcomes of Elderly Patients with Potentially Curable Esophageal Cancer

Yang

Xie

et al. 2021

Preprint

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Background: The proportion of elderly patients with esophageal cancer (EC) is increasing due to prolonged life expectancy and aging process. However, the optimal treatment strategy for elderly patients (aged ≥70 years) with EC remains controversial.Methods: Eligible patients with cT1b-4aNxM0 EC were identified in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. Treatment patterns were divided into five groups: surgical resection (S), chemoradiotherapy (CRT), radiotherapy (RT), chemotherapy (CT), or observation with no treatment (Obs). Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS).Results: A total of 3233 patients with potentially curable EC were identified. Of all the patients included, 29.1%, 48.2%, 8.7%, and 3.5% received S, CRT, RT, and CT, respectively, whereas 10.5% underwent Obs. The 3-year OS estimates were 45.8% (95% confidence interval [CI]: 42.2–49.8%), 26.1% (95% CI: 23.5–28.9%), 12.2% (95% CI: 8.4–17.8%), 14.9% (95% CI: 8.4–26.4%), and 6.7% (95% CI: 4.0–11.0%) for S, CRT, RT, CT, and Obs (p<0.001), respectively. However, the survival benefits of surgery over CRT gradually weakened with the increase in age, and the survival benefit of surgery was statistically non-significant for EC patients aged ≥80 years (p=0.41). Multivariate analysis showed that treatment patterns, age, tumor grade, T stage, N stage, and marital status were significantly associated with OS.Conclusion: Generally, the use of surgery was associated with the longest OS, and CRT was superior to RT or CT alone in elderly patients with curable EC. For patients intolerable to surgery or aged ≥80 years, definitive CRT should be considered as a preferable option. The optimal treatment strategy for elderly patients with EC should consider comprehensive geriatric assessment, survival benefit, and patient preference in a multidisciplinary setting.

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“…Studies comparing concurrent chemoradiation with single agent versus multi agent chemotherapy have also suggested that single-agent chemoradiation are not inferior to multi-agent treatment in terms of outcomes, and are better tolerated with good toxicity profiles [18][19]. Again these are retrospective, institutional experiences.…”

Section: Discussionmentioning

confidence: 99%

Definitive Chemoradiation with Concurrent Weekly Cisplatin in the Treatment of Esophageal Squamous Cell Carcinoma – A Simplistic Approach

Ahmed¹,

Krishnamurthy

Bhise

2021

Asian Pac J Cancer Care

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Purpose: Chemoradiation is the standard of care in locally advanced/ inoperable esophageal squamous cell cancer (ESCC). Though combination chemotherapy with Cisplatin and 5-Fluorouracil is the standard, it has low compliance due to toxicities and prolonged treatment time. Hence there is a window of opportunity to explore a safer chemotherapy regimen without compromising the treatment outcome. Methods: 55 patients of ESCC who were treated with definitive External Beam Radiotherapy (EBRT) to a dose of 50.4 – 59.4 Gray and concurrent weekly Cisplatin (or Carboplatin) were retrospectively evaluated for treatment efficacy and outcomes. 2 year Overall Survival (OS) and Progression Free Survival (PFS) were evaluated. Prognostic variables were assessed with respect to OS in Univariate analysis. Results: Median age at presentation was 58 years. 29 (53%) had lesion in the upper third of esophagus. 40 (72%) had T3 disease and 31 (56%) were node positive. All patients (100%) completed planned radiotherapy dose. 54 (98%) received 4 or more cycles of weekly chemotherapy. Mean overall treatment time was 43 days. Only 7 patients (12.7%) had grade 3 or more acute toxicity. 36 (65.5%) had complete response. At median follow-up of 13.7 months, the median OS was 15.2 months and 2 year OS was 42.6%. On univariate analysis, patients with comorbidities and lower third lesion had poor OS (p=0.016 and p=0.002). Stage II disease and complete response to treatment showed better OS (p=0.02 and p=0.00). Conclusion: Radical chemoradiation with weekly Cisplatin in ESCC is a simple and effective regimen which needs to be explored in larger trials.

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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

Cited by 18 publications

References 27 publications

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients: A phase II clinical trial

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients: A phase II clinical trial

Treatment patterns and Outcomes of Elderly Patients with Potentially Curable Esophageal Cancer

Definitive Chemoradiation with Concurrent Weekly Cisplatin in the Treatment of Esophageal Squamous Cell Carcinoma – A Simplistic Approach

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