Combined modality chemoradiation in elderly oesophageal cancer patients

Abstract

We present a single institution experience with 5-FU, mitomycin-C based chemoradiation for the primary treatment of elderly patients with oesophageal cancer. Twenty-five patients with a median age of 77 years (range 66 -88) with a diagnosis of stage II -III squamous cell or adenocarcinoma of the oesophagus were treated at Memorial Sloan Kettering from 1996 to 2001 with two cycles of concurrent 5-FU, mitomycin-C and 50.4 Gy. Owing to age and comorbidity, these patients were not considered surgical candidates. The Charlson comorbidity score was used to evaluate patient comorbidity. Nine patients (36%) experienced grade 3 -4 haematologic toxicity. Of the 23 patients evaluable for response, 17 patients (68%) had a negative post-treatment endoscopy and CT scan without evidence of progressive disease. Eleven patients (44%) are alive and 10 (40%) remain without evidence of recurrent or progressive oesophageal cancer at a median follow-up of 35 months. The median overall survival was 35 months and 2-year survival 64%. There was no significant difference in overall survival between Charlson score p2 and those with a score X2 (P ¼ 0.10). Similar survival was observed for patients with adenocarcinoma or squamous carcinoma. Primary chemoradiation with two cycles of 5-FU, mitomycin-C, and 50.4 Gy in elderly patients is an active regimen with moderate toxicity, despite the advanced age and heavy comorbidity burden of this cohort. Patients with local/regional oesophageal cancer with adequate functional status should not be excluded from potentially curative treatment based on age alone.

Short- and long-term outcomes of definitive chemoradiotherapy in patients with esophageal carcinoma aged ≥75 years

“…Our results indicated that CRT was an effective treatment for EC patients aged ≥75 years. Our results also indicated that patient selection and the short-and long-term outcomes of CRT for elderly patients were considered acceptable, which is in accordance with the results reported in previous studies (7,13). Our study mainly focused on those patients who required treatment discontinuation or a reduction in treatment dose.…”

“…In our study, the proportion of patients with a Charlson score of ≥2 who discontinued their treatment was significantly higher in the dCRT group compared to that in the other groups, although there were no differences in the PS. Anderson et al (13) reported that there was a correlation between a Charlson score of ≥2 and grade 3 or 4 toxicity. In the present study, the proportion of patients aged ≥85 years in the dCRT group was significantly higher compared with that of patients aged ≤85 years and the number of patients with ≥3 grade toxicity in this group was also higher compared to that in the other groups.…”

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

“…Anderson et al reported a correlation between a Charlson comorbidity score of ! 2 and grade 3 or 4 toxicity of CRT (29). The patient's age, multiple comorbidities, and poor performance status often become critical fatal issues for the patients during and after surgery or CRT/RT.…”

Management and Outcomes of Localized Esophageal and Gastroesophageal Junction Cancer in Older Patients

“…Because concerns about toxicity, comorbidities, and poor outcome in general, physicians tend to be conservative in managing older patients 9,10 . A few retrospective reports [9][10][11][12] and a single-armed phase ii trial 13 showed that chemoradiotherapy (crt) is feasible and efficacious in older patients; however, other reports raise significant concerns about treatment-related toxicities 14 .…”

“…The definition of "elderly population" remains controversial in literature, variably using the stated age cut-offs of 65, 70, and 75 years [9][10][11][12][13][14] . We choose 70 years of age and older to define this group of patients because, historically, patients older than 71 have been excluded from many clinical studies evaluating treatment for esophageal cancer 10 .…”