Background/Aim: To evaluate the predictive factors in older patients with localized esophageal cancer treated with definitive radiotherapy. Patients and Methods: We retrospectively analyzed patients aged ≥75 years who were treated with three-dimensional conformal radiotherapy between 2008 and 2017. The patients were classified into the oldest-old group (≥80 years) and the old group (75-79 years). Results: Fifty patients were identified, 28 in the oldest-old group and 22 in the old group. Forty-six patients (92%) completed the planned radiotherapy. The median follow-up time was 21 months. Two-year overall survival (OS), disease-free survival, and locoregional control rates were 53%, 42%, and 51%, respectively. Univariate analyses for OS showed that neither the radiotherapy field nor total radiotherapy dose was a significant factor. Clinical T stage, clinical N stage, and age were independent predictors of OS. Conclusion: Age ≥80 years is an independent prognostic factor for OS. Elective nodal irradiation and total radiotherapy dose above 50.4 Gy did not improve survival. Our findings may help in the treatment decisions for localized esophageal cancer in older patients. The number of older individuals has rapidly increased in Japan. At present, people aged 65 years or older comprise 28.1% of the Japanese population, including 14.2% of the population in late-stage old age (aged 75 years or older) (1). Cancer is the leading cause of death in the older population. Aging in the Japanese population and increased life expectancy means that cancer in older adults is becoming an increasingly common social issue. Esophageal cancer remains one of the most fatal cancers worldwide (2, 3). It occurs mainly in middle-aged and older people. In Japan, esophageal cancer was responsible for 11,483 deaths in 2016, accounting for 3.1% of all cancer deaths in the country. In 2013, of the 22,812 patients with esophageal cancer in Japan, about half were older than 75 years (4). Although older patients with localized esophageal cancer are less subjected to aggressive treatment, any treatment, including palliative care, may be associated with an improved survival rate (5). Despite progress in surgical techniques, esophagectomy is associated with significant morbidity and mortality, and 75 years is often considered the age limit for this type of surgery (6). For patients who are either deemed medically inoperable or have tumors that are unresectable, the efficacy of definitive chemoradiation (CRT) has been established in numerous randomized, controlled trials (7, 8). The 2018 National Comprehensive Cancer Network guidelines recommend definitive CRT with fluorouracil and cisplatin, using a radiotherapy (RT) dose of 50.4 Gy as the standard care for patients with esophageal cancer who are not suitable for surgery (9). However, older patients are under-represented in these trials (7, 8), and little is known about data on the efficacy and safety of definitive RT for patients older than 75 years with localized esophageal cancer. RT is a less inva...

Background/Aim: Radiotherapy is widely accepted as the treatment of choice for early glottic squamous cell carcinoma (EGSCC), although it varies greatly with respect to dose, dose per fraction, and treatment techniques. The study aim was to evaluate the use of accelerated fractionation strategy (AFS) for EGSCC in standard clinical practice. Patients and Methods: Patients treated with definitive radiotherapy for EGSCC between 2008 and 2019 were retrospectively identified and received either conventional fractionation, hypofractionation, or hyperfractionation. Results: One hundred six patients were analyzed, and 19, 71, and 16 patients underwent conventional fractionation, hypofractionation, and hyperfractionation, respectively. The median follow-up was 56 months. The 5-year local control and overall survival rates were 79% and 83%; 78% and 79%; and 87% and 77%, respectively, and no significant difference was observed between the fractionation schedules. Conclusion: Our findings confirmed the utility of AFS in standard clinical practice and support its use for patients with EGSCC.

Penoscrotal extramammary Paget’s disease (EMPD) is a rare intraepithelial adenocarcinoma in older male patients, and no effective nonsurgical treatment strategies are currently available. The aim of this study was to report the usefulness of external radiotherapy (RT) for penoscrotal EMPD in an inoperable elderly patient. This report presents the treatment of an 89-year-old man with widespread penoscrotal EMPD. A multidisciplinary treatment team decided on radical RT. The patient received a radiation dose of 61.8 Gy in 30 fractions through electron and photon beams. His treatment tolerance was good, and no severe toxicity had been observed up the last follow-up. At 6.5 years after the RT, the patient showed no evidence of recurrence. Definitive RT resulted in excellent disease control and minimal toxicity; thus, it could be a promising nonsurgical therapeutic option for penoscrotal EMPD, even in extremely elderly individuals.