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

Abstract

Background: The aim of the present study was to assess the efficacy of concurrent chemoradiotherapy (CRT) or radiotherapy alone (RT-alone) in elderly patients with esophageal squamous cell carcinoma (ESCC). Methods: The clinical data of patients with ESCC treated with RT-alone or CRT were collected and retrospectively reviewed. The 1-, 3-and 5-year overall survival (OS) rates and the clinical characteristics correlated with survival were analyzed statistically. Propensity score matching (PSM) analyses were used to compensate for differences in baseline characteristics between the CRT and RT-alone groups to confirm the survival difference. Results: A total of 729 patients fulfilling the inclusion criteria were reviewed. Diabetes, primary tumor volume (pTV), primary tumor location (pTLo), clinical T stage,(cT) clinical N stage (cN), clinical M stage (cM) and short-term response to RT were independent factors influencing OS (P = 0.002-0.044). The 5-year OS rate was 26.6, 26.0 and 30.1% in the whole cohort, RT-alone and CRT groups, respectively. The survival difference between RT alone and CRT was not significant before or following PSM. Compared with the corresponding subgroups treated with RT alone, CRT significantly benefited patients with diabetes (P = 0.003), cT4 (P = 0.030) and cN0 (P = 0.049), whereas no benefit was identified between CRT and RT alone in the other subgroups, including cT1-3, cN1, cM, pTLo, pTV, age and gender. Conclusions: CRT with the current chemotherapy regimens may not improve the survival of elderly ESCC patients compared to RT-alone, except in patients with cT4 stage, cN0 stage or diabetes. However, due to the limitation of the retrospective nature of the current study, further clinical trials are required for confirmation.

Management of elderly patients with esophageal squamous cell cancer

“…Takeuchi reported a retrospective analysis showing significant inferior efficacy, even in selected patients ( 60 ). Chen also reported CRT may not improve the survival of elderly ESCC patients ( 61 ). Jingu suggested CRT should be carefully selected ( 62 ).…”

Long-Term Results of a Phase 2 Study of Definitive Chemoradiation Therapy Using S-1 for Esophageal Squamous Cell Carcinoma Patients Who Were Elderly or With Serious Comorbidities

“…compared patients ≥80 years with esophageal cancer treated with conventional dCRT with 2 younger patient cohorts (65–79 years and <65 years) treated with dCRT by propensity score matching and showed that the elderly cohort exhibited statistically significant evidence of an increased rate of severe radiation pneumonitis ( 12 ). Several studies have suggested that dCRT improves overall survival in elderly patients only in locally advanced stage compared with RT alone ( 13 , 14 ). Since elderly patients have unique issues, namely, life expectancy, comorbidities, and the risk of treatment-induced morbidity, chemoradiotherapy requires careful consideration and should be carefully selected in elderly EC patients ( 10 ).…”

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

“…After PSM, 3,020 patients were included for further analysis, the 3- and 5-year OS and CSS in the CRT group were longer than those in the RT-alone group in five subgroup analyses stratified by age (ages 65–69; 70–74; 75–79; 80–84; ≥85, respectively). The 5-year survival rate of elderly cancer patients undergoing radical radiotherapy or radiochemotherapy is 9.7%~30.1% ( 18 , 19 ). Many previous clinical research results were consistent with our reports.…”