Chemoradiotherapy Is Superior to Radiotherapy Alone in Esophageal Cancer Patients Older Than 65 Years: A Propensity Score-Matched Analysis of the SEER Database

Xia, Xiaojie; Gao, Qing; Ge, Xiaolin; Liu, Zeyuan; Di, Xiaoke; Sun, Xinchen; Yang, Yan

doi:10.3389/fonc.2021.736448

Cited by 5 publications

(8 citation statements)

References 26 publications

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“…For example, in a large retrospective analysis of the SEER database, 3020 elderly patients (≥ 65 years) with esophageal cancers treated with chemoradiation or radiotherapy alone were analyzed. In this analysis, the five-year overall and cancer-specific survival rates were only 13% and 20%, respectively; comparing the treatment modalities by propensity-score matching, a significant survival benefit of chemoradiotherapy versus radiotherapy was evident regardless of patient age (8). Other retrospective studies of elderly patients with esophageal cancer reported 5-year OS rates in the range of 5 -36% after (chemo)radiotherapy (17,18).…”

Section: Discussionmentioning

confidence: 66%

“…However, despite the high clinical importance, available data for esophageal cancer therapy in the elderly are mainly derived from retrospective studies except for one recent prospective randomized study that reported survival of elderly esophageal cancer patients after chemoradiotherapy with S-1 or radiotherapy alone (8,9,(13)(14)(15)(16)(17). Most reports analyzed elderly esophageal cancer patients with both adenocarcinomas and SCCs, and most of these studies have demonstrated a survival benefit for additional concomitant chemotherapy, including the only published prospective study to date with an exclusively elderly patient population (9).…”

Section: Discussionmentioning

confidence: 99%

“…To date, there are only few datasets available that investigated the benefit of standard chemoradiotherapy for the treatment of esophageal cancers in the elderly (7)(8)(9). Our study aimed to analyze toxicity profiles and oncologic outcomes in a large multi-center cohort of elderly ESCC patients treated with neoadjuvant or definitive (chemo)radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Bostel

Akbaba²,

Wollschläger³

et al. 2023

Front. Oncol.

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Background and purposeTo evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).Materials and methodsThis multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed.ResultsThe delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001).ConclusionsChemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Bostel

Akbaba²,

Wollschläger³

et al. 2023

Front. Oncol.

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“…29,31,32 Moreover, a recent study demonstrated that chemoradiotherapy was superior to radiotherapy alone in elderly EC patients. 33 Hence, there is no doubt that active therapy could prolong the survival of patients. However, in clinical settings, chemotherapy and radiotherapy are usually administered to patients with good performance status (PS); hence, selection bias could exist in this study.…”

Section: Discussionmentioning

confidence: 99%

Models for Predicting Early Death in Patients With Stage IV Esophageal Cancer: A Surveillance, Epidemiology, and End Results–Based Cohort Study

Shi

Zhai

2022

Cancer Control

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Background Despite enormous progress in the stage IV esophageal cancer (EC) treatment, some patients experience early death after diagnosis. This study aimed to identify the early death risk factors and construct models for predicting early death in stage IV EC patients. Methods Stage IV EC patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were selected. Early death was defined as death within 3 months of diagnosis, with or without therapy. Early death risk factors were identified using logistic regression analyses and further used to construct predictive models. The concordance index (C-index), calibration curves, and decision curve analyses (DCA) were used to assess model performance. Results Out of 4411 patients enrolled, 1779 died within 3 months. Histologic grade, therapy, the status of the bone, liver, brain and lung metastasis, marriage, and insurance were independent factors for early death in stage IV EC patients. Histologic grade and the status of the bone and liver metastases were independent factors for early death in both chemoradiotherapy and untreated groups. Based on these variables, predictive models were constructed. The C-index was .613 (95% confidence interval (CI), [.573–.653]) and .635 (95% CI, [.596–.674]) in the chemoradiotherapy and untreated groups, respectively, while calibration curves and DCA showed moderate performance. Conclusions More than 40% of stage IV EC patients suffered from an early death. The models could help clinicians discriminate between low and high risks of early death and strategize individually-tailed therapeutic interventions in stage IV EC patients.

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“…In five subgroups based on the age stratification (65-69; 70-74; 75-79; 80-84; ≥ 85 years), the 3- and 5-year OS showed significant benefits in the chemoradiotherapy group compared with the RT alone group (all P < 0.05). The authors thus concluded that chemoradiotherapy could significantly improve survivals in non-surgical EC patients older than 65 years[ 8 ]. Although the modes [3-dimensional conformal RT (3DCRT) or IMRT], dosage (50-60 Gy), range (prophylactic irradiation of high-risk lymphatic drainage areas or not), and concurrent chemotherapy regimens (including platinum plus 5-fluorouracil, platinum plus paclitaxel, platinum plus capecitabine, and single-agent regimen) of RT varied among different studies[ 9 - 13 ], the safety and efficacy of concurrent chemoradiotherapy in elderly patients have been well demonstrated, with the ORR 56.7%-84.0%, the median OS 9-35 mo, and the 2-year OS rate 27%-78%.…”

Section: Discussionmentioning

confidence: 99%

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer

Liu¹,

Yan²,

Di³

et al. 2022

WJCC

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BACKGROUND It is estimated that about 30% of esophageal cancer (EC) patients are over 70 years old. Therefore, there is less evidence on the diagnosis and management of elderly EC patients. It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens, including the target area of radiotherapy (RT), radiation dose and fraction, and choice of chemotherapy drugs. AIM To compare the efficacy of involved-field intensity-modulated RT (IF-IMRT) combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety, short-term response, and survival. METHODS Thirty-four EC patients aged > 70 years were prospectively enrolled between December 2017 and December 2019. Based on the random number table, they were divided into an IF-IMRT + S-1 group and an IF-IMRT alone group, with 17 patients in each group. All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions (1.8-2 Gy/fraction, 5 fractions/wk). Oral S-1 was administered concomitantly in the IF-IMRT + S-1 group for 14 consecutive days, and a second cycle was started 7 d after drug withdrawal. After RT, 4 cycles of S-1 treatment were offered as the consolidation chemotherapy. The safety, short-term response, and survival were observed after the treatment. RESULTS As of April 2022, these 34 patients had been followed up for 15.2-32.5 mo, with a median follow-up period of 24.5 mo. Complete efficacy indicators were obtained from all the patients. The objective response rate was 88.2% vs 76.5%, respectively, in the IF-IMRT + S-1 group and the RT alone group, where as the disease control rate was 100% vs 82.4%, respectively. The incidence of adverse events including grade 1-2 fatigue, granulocytopenia, thrombocytopenia, anemia, radiation esophagitis, radiation-induced skin injury, and radiation-induced lung injury was not significantly different between these two groups, so was the incidence of the grade 3 radiation esophagitis (0% vs 5.7%). The rate of progressive disease (PD) was 52.9% ( n = 9) in the IF-IMRT + S-1 group and 64.7% ( n = 11) in the RT alone group. The median progression-free survival (PFS) was 23.4 mo vs 16.3 mo, and the 2-year PFS rate was 42% vs 41.2%. The median overall survival (OS) was 27.0 mo vs 23.0 mo, and the 2-year OS rate was 58.8% vs 47.1%. Multivariate analysis showed that age was a significant prognostic factor ( P = 0.0019); patients aged < 75 years had a significant survival advantage over patients aged ≥ 75 years. The locations of EC also affected the prognosis. In the IF-IMRT + S-1 group, the number of chemotherapy cycles was a significant prognostic factor ( ...

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Chemoradiotherapy Is Superior to Radiotherapy Alone in Esophageal Cancer Patients Older Than 65 Years: A Propensity Score-Matched Analysis of the SEER Database

Cited by 5 publications

References 26 publications

Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

Models for Predicting Early Death in Patients With Stage IV Esophageal Cancer: A Surveillance, Epidemiology, and End Results–Based Cohort Study

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer

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