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

Qu, Xuanlu; Biagi, James; Banashkevich, A.; Mercer, C. D.; Tremblay, Lise; Mahmud, Aamer

doi:10.3747/co.22.2661

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…Several authors investigated the accessibility of EP to different treatment options [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Among EP with curable disease, only 50–69% seemed to receive treatment with curative intent [ 12 , 13 , 15 , 16 ]. Münch et al even report that for similar tumor stages with YP, 25% of EP received palliative and not curative treatment [ 19 ].…”

Section: Resultsmentioning

confidence: 99%

“…Münch et al even report that for similar tumor stages with YP, 25% of EP received palliative and not curative treatment [ 19 ]. The most frequently used modality was definitive chemoradiation (DCRT) in 37–64% of EP [ 12 , 13 , 14 ], while only 7–36% of them were offered surgery [ 12 , 13 , 15 , 16 , 17 , 18 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…However, in all of the above studies any given treatment offered a substantial survival benefit for EP [ 12 , 13 , 15 , 16 , 17 , 18 ]. Median overall survival (OS) after curative treatment was 18–19 months, 6–9 months longer than palliative strategies [ 13 , 16 ]. The best results are reported after neoadjuvant treatment and surgery (NATS), followed by upfront surgery and DCRT [ 12 ]; indeed, surgery compared to non-surgical treatment increased median OS from 5–10 to 18–22 months [ 17 , 18 ], and 5-year OS from 3% to 23% [ 15 ].…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

Mantziari

Farinha

Bouygues

et al. 2021

Cancers

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Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70–79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

Mantziari

Farinha

Bouygues

et al. 2021

Cancers

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“…13 The results of a phase II, single-arm study evaluating platinum-based chemotherapy combined with radiotherapy in patients older than 75 years with esophageal carcinoma suggested that chemotherapy is feasible and tolerable in elderly patients. 14 Meanwhile, there have been several retrospective studies [14][15][16][17][18][19][20][21][22][23][24] in elderly patients with OC had indicated that concurrent chemoradiation might be an optimal strategy for elderly patients with OC. Studies with more than 20 patients were listed in Table 6.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and efficiency of concurrent chemoradiotherapy with a single agent or double agents vs radiotherapy alone for elderly patients with esophageal squamous cell carcinoma: Experience of two centers

Huang

Zhu

et al. 2019

Cancer Medicine

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The incidence of elderly patients with esophageal cancer (OC) is increasing as the population ages. Until now, the treatment strategy in these patients has been unclear. The aim of our study was to assess the efficiency and tolerance of treatment with radiotherapy alone (RT alone), single‐agent‐based concurrent chemoradiotherapy (CCRT‐1), or double‐agent‐based concurrent chemoradiotherapy (CCRT‐2) in elderly patients (≥65 years) with OC. A total of 271 patients with OC aged 65 years or older were included in this study. The median overall survival (OS), median progression‐free survival (PFS), overall response rate (ORR), disease control rate (DCR), and treatment‐related toxicities were assessed. The median OS time for all patients was 23.6 ± 2.3 months, with 2‐year survival rates of 48.0 ± 3.0%. The median PFS time was 13.6 ± 1.3 months with the 2‐year PFS rate was 33.0 ± 4.0%. Among patients who received CCRT‐1, better OS, and PFS were found in patients who received docetaxel than in patients received fluorouracil and platinum. In a subgroup analysis, 118 patients who underwent RT alone had a median OS time of 15.6 ± 1.9 months and median PFS time of 10.4 ± 0.9 months. The median OS time of patients who received CCRT‐1 was 28.8 ± 10.1 months compared with 27.8 ± 2.5 months for the patients treated with CCRT‐2 (P = 0.537). The similar results were observed for median PFS, with 16.5 ± 3.2 months in the CCRT‐1 group and 17.0 ± 2.0 months in the CCRT‐2 group (P = 0.321). Grade ≥3 leukocytopenia and grade ≥2 weight loss during treatment occurred in 40.6% and 17.9% of patients, respectively, in the CCRT‐2 group, which was higher than that observed in the CCRT‐1 group. Our results suggested that CCRT could be considered as an acceptable treatment for elderly patients with OC. The CCRT‐1 group presented with a lower incidence of treatment toxicities but comparable survival outcomes, compared to the CCRT‐2 group. Docetaxel was superior to fluorouracil and platinum in terms of OS.

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Outcomes from a single institution cohort of 248 patients with stage I–III esophageal cancer treated with radiotherapy: Comparison of younger and older populations

Lavergne,

Youssef,

Niglas

et al. 2024

Technical Innovations & Patient Support in Radiation Oncolo

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

Abstract: Background Older patients are commonly excluded from clinical trials in esophageal and gastroesophageal

Cited by 5 publications

References 30 publications

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis

Feasibility and efficiency of concurrent chemoradiotherapy with a single agent or double agents vs radiotherapy alone for elderly patients with esophageal squamous cell carcinoma: Experience of two centers

Outcomes from a single institution cohort of 248 patients with stage I–III esophageal cancer treated with radiotherapy: Comparison of younger and older populations

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