Is Concurrent Chemotherapy With Radiotherapy for Esophageal Cancer Beneficial in Patients Aged 80 Years or Older?

Abstract

Background/Aim: To determine whether concurrent chemotherapy with radiotherapy should be performed in elderly patients with esophageal cancer. Patients and Methods: A total of 185 patients aged 80 years or older who were treated with definitive radiotherapy alone or combined with chemoradiotherapy for esophageal cancer at seven institutions were enrolled. In order to compare survival rates of patients treated with chemoradiotherapy with those of patients treated with radiotherapy alone, propensity score matching was performed to homogenize the two populations. Results: For the whole patient cohort, the 3-year overall survival (OS) rate was 52.6% and the median survival was 42.5 months. After propensity score matching, the 3-year OS rate for the chemoradiotherapy group was not significantly better than that for the group treated with radiotherapy alone (53.7% vs. 59.9%, p=0.876). Conclusion: Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older did not have significant OS benefit over radiotherapy alone. Esophageal cancer is the fifth most common cause of cancerrelated death worldwide for men and the eighth most common cause of cancer-related death worldwide for women (1). Since the Radiation Therapy Oncology Group (RTOG) 85-01 trial showed that the outcome of definitive chemoradiotherapy was significantly better than that of radiotherapy alone for patients with esophageal cancer (2), concurrent chemoradiotherapy has been a standard treatment for esophageal cancer. However, most patients aged 80 years or older are unlikely to be able to tolerate chemotherapy. There are about 4,000 patients aged 80 years or older with esophageal cancer in Japan every year. Miyata et al. reported that elderly patients aged 80 years or older who underwent surgery for esophageal cancer had a poorer prognosis than did younger patients because a smaller percentage of elderly patients received neoadjuvant therapy (3). They concluded that aggressive treatment may be recommended for elderly patients. Based on data from Surveillance, Epidemiology, and End Results (SEER), patients aged 80 years or older with esophageal cancer benefit from radiotherapy alone compared to no radiotherapy if the cancer is in a localized/regional stage (4). The results of analysis of data in a Japanese nationwide database showed that radiotherapy alone tended to be performed for elderly patients (5). There is no definitive evidence of a beneficial effect of concurrent chemotherapy with radiotherapy for elderly patients with esophageal cancer. The purpose of the present study was to determine whether concurrent chemotherapy with radiotherapy rather than radiotherapy alone should be administered to patients with esophageal cancer aged 80 years or older. Patients and Methods Patient eligibility. The eligibility criteria included i) histopathologically proven esophageal cancer; ii) clinical stage T1-4; N0-1; M0/M1 lym [International Union Against Cancer (UICC) 2002)] (6); iii) 80 or more years of age; iv) no history of rad...

Concurrent chemoradiotherapy versus radiotherapy alone for patients with locally advanced esophageal squamous cell carcinoma in the era of intensity modulated radiotherapy: a propensity score‐matched analysis

“…In the subgroup analysis, for elderly patients (age 70 years or older), CCRT did not show a significant survival advantage over RT alone. This result is consistent with some recently published retrospective analyses of elderly patients 14 . This can be related to the poor tolerance of elderly patients for CCRT.…”

Concurrent Chemoradiotherapy Versus Radiation Monotherapy for Patients with Locally Advanced Esophageal Squamous Cell Carcinoma in the Era of Intensity Modulated Radiotherapy: A Propensity Score-matched Analysis

“…In the subgroup analysis, for elderly patients (aged 70 years or older), CCRT did not show a signi cant survival advantage over RT alone. This result is consistent with some recently published retrospective analyses of elderly patients [14]. This can be related to the poor tolerance of elderly patients for CCRT.…”

Differences in treatment and survival between elderly patients with thoracic esophageal cancer in metropolitan areas and other areas

“…Furthermore, patients with cStage I esophageal cancer rarely present with symptoms such as dysphagia and are often treated as outpatients. Because radiation monotherapy is less toxic than chemoradiotherapy, 11 it tends to be readily performed, even at facilities that are less familiar with the use of radiotherapy for thoracic esophageal cancer.…”