Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients

Abstract

Purpose: The reported data of elderly ESCC are rather limited and there is a lack of information to guide treatment decisions for elderly patients with esophageal cancer. This study aims to identify the efficacy and factors for optimal treatment approaches for elderly esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) alone or concurrent chemoradiation (CCRT).Methods: This study included 184 I-III elderly ESCC patients aged ≥70 years treated by oral single agent CCRT (sCCRT) or double agents CCRT (dCCRT) or RT alone at a single institution in China. RT was delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Sequential or simultaneous integrated boost (SIB) approach was applied for GTV dose escalation. Toxicities were evaluated by criteria of Radiation Therapy Oncology Group. Statistical analyses were performed on survival and failure patterns.Results: At a median follow-up time of 15.5 months, the 2- and 3-year estimated overall survival (OS) were 43.5% and 35.2%, respectively. T and N stage, GTV dose (cutoff value 56Gy), simultaneous integrated boost (SIB) technique and CCRT were significant predictors for the outcomes. sCCRT was significantly associated with higher OS, LRFS, and DFS when compared with RT alone and no difference was observed between sCCRT and dCCRT. 44% patients experienced treatment failure, among whom 65.4% developed local failure. 81.3% local failure occurred in GTV and 70.6% regional failures occurred out of radiation field. dCCRT was the only independent prediction factor for grade ≥ 2 neutropenia and gastrointestinal reactions compared with sCCRT and RT alone. No significant difference of toxicities was observed between sCCRT and RT alone.Conclusions: Our results demonstrated that CCRT in elderly patients had significant survival benefit compared to RT alone, especially using Single oral agent. sCCRT had less toxicities compared to dCCRT, and the toxicity was similar to RT alone. GTV dose ≥ 56 Gy and SIB technique were optimal approaches for radiotherapy.

Definitive Radiotherapy for Older Patients Aged ≥75 Years With Localized Esophageal Cancer

“…One reason for these may be that our study included a relatively large number of patients with early-stage cancers. Age is an independent prognostic factor of OS in our study, which is different from the results of other studies (14,18,23). Huang et al suggested EC patients aged ≥80 benefit from RT only if the cancer is in localized/regional stage (24).…”

“…Our results showed that RT in older patients resulted in good OS, with 2-year estimated OS, DFS, and LRC of 53%, 42%, and 51%, respectively, and a median OS time of 30 months ( Figure 1). Interestingly, our results were comparable to or slightly better than those of previous studies on patients younger than those in our study (14,18,(21)(22)(23) (Table V). In addition, only 10% of patients failed at distant sites, which is relatively low compared to the literature in which about 13-37% is expected (7,8,14,18,23).…”

“…It is hoped that future studies will further develop RT for localized esophageal cancer, including for older patients. Most of what we know about RT for older patients with esophageal cancer has been learned from studies on patients over the age of 70 (14)(15)(16)(17)(18), and data on the efficacy and safety for patients over the age of 75 are limited (19,20). Many studies included patients with all clinical stages of esophageal cancer, including M1 (distant organ metastases), and little is known about definitive RT in older patients with localized esophageal cancer.…”

“…In general, older patients have decreased tolerance to chemotherapy. Some previous studies suggested that CCRT even in older patients had survival benefits compared with RT alone (14,15,17,26). However, most of these studies targeted patients over 70 years of age and not patients over 75 years of age.…”

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

“…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]. Similar to Zhao et al, in the current study, the survival of patients treated with CRT with various CC regimens or CC cycles did not alter significantly.…”