Clinical Features of Esophageal Cancer in the Octogenarian Treated by Definitive Radiotherapy: a Multi-institutional Retrospective Survey

Abstract

Background: As age-related infirmity often influences treatment options and outcome of esophageal cancer, the optimization of treatment for the elderly, especially in octogenarians, has been the subject of considerable debate. Methods: We performed a retrospective, multi-institutional survey to assess the effectof age on the outcome of definitive radiotherapy for esophageal cancer by a questionnaire sent to eight institutions in Japan. Results: Therewere362evaluable replies. Thepatients included 317 males and 45 females, with a median age of 72 years (range 35-93 years), and 96% had squamous cell carcinoma. There were30 clinical stage I, 71 stage IIA,17 stage IIB, 113 stage III and 116 stage IV cases. The stage was not specified in 16 cases. Multiple co-morbidities existed in 40°!c> of the patients who were 70 years of age or older. Therewas no statistically significant age-related difference in the incidence of adverse reactions to radiotherapy (P > 0.05). Overall survival was more significantly affected by Karnofsky Performance Statusthan by the patient's age. The influence of performance status on cumulative survival for stage I and II disease was more pronounced in patients in their 80s. Conclusion: The safety of radiotherapy for esophageal carcinoma is not influenced by the patient's age. Because the performance status strongly influenced survival, the multi-disciplinary assessment of functional status is mandatory for optimizing the choice of treatmentfor patients in their 80s with esophageal cancer.

Elevated interleukin-18 serum levels in chronic schizophrenia: Association with psychopathology

“…Furthermore, our finding of high IL-18 levels accords with previous reports that showed increased IFN-g levels in schizophrenic patients (Miller et al, 2011), since IL-18 may induce IFN-g secretion (Felderhoff-Mueser et al, 2005). More broadly, many studies have reported elevated expression of IL-18 in autoimmune diseases, such as rheumatoid arthritis (Kawashima et al, 1996) and adult onset Still's disease (Kawashima et al, 1998). Moreover, the potential contribution of IL-18 to acute and chronic neuroprogression has been extensively investigated in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE; the animal model for MS).…”

Prognostic Significance of CYFRA21-1, CEA and Hemoglobin in Patients with Esophageal Squamous Cancer Undergoing Concurrent Chemoradiotherapy

“…For patients with early stage disease (І, ПA and ПB), the overall survival rate of the octogenarians was significantly affected by the KPS (P = 0.009), while the KPS did not affect the survival of younger patients (P = 0.958). In contrast, for the advanced stages (Ш and IV), the overall survival of the patients younger than 80 years was affected significantly by the KPS (P =0.048), whereas it was not in the octogenarians (P =0.963) (Kawashima M, 1998).…”

Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review

“…Kawashima et al reported that a higher KPS (≥80 versus ≤70) was associated with a higher overall survival in patients treated with definitive radiotherapy (RR 1.56 p = 0.0009). If the data were stratified for age, the overall survival rate of 31 octogenarians (stage I/II) was significantly higher with increasing KPS (p = 0.009), while it did not associate with increasing survival in the 63 younger patients (p = 0.958) [25].…”

“…Nine of the associations reporting on overall functional performance used the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ)-C30 [18][19][20][21][22][23], four used the Karnofsky Performance Score (KPS) [18,21,24,25], six used the Eastern Cooperative Oncology Group (ECOG) score, three used the Zubrod performance score [26,27] and two used Barthel index and Instrumental Activities of Daily Living (IADL) [28]. Functional impairment was prevalent in most of the studies with rates between 14 and 67%.…”