Multicenter questionnaire survey on patterns of care for elderly patients with esophageal squamous cell carcinoma by the Japan Esophageal Oncology Group

Hamamoto, Yasuo; Akutsu, Yasunori; Nagashima, Fumio; Hironaka, Shuichi; Ito, Yoshiaki; Kato, Ken; Tsubosa, Yasuhiro; Nakagawa, Satoru; Daiko, Hiroyuki; Ozawa, Soji; Kitagawa, Yuko

doi:10.1093/jjco/hyv183

Cited by 11 publications

(9 citation statements)

References 24 publications

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“…More recently, De Boer et al developed a survey to assess patterns of care in cervical cancer, but they focused only on radiotherapy modalities, and in a single country [9]. As in our work, Hamamoto et al observed in a Japanese study on esophageal carcinoma that the preferred strategy in fit older patients was the same as in younger ones [10]. Once again, similarly to our study, radiation alone was preferred in frail patients.…”

Section: Discussionsupporting

confidence: 78%

“…This observation questions current clinical practices for older patients with cancer, as highlighted by the rare use of a screening tool for frailty and the low referral to dedicated multidisciplinary teams. Similarly, Hamamoto et al observed that geriatric scales were not a main factor for decision-making in this population [10], while Oosting et al reported that only 13% of centers routinely perform geriatric assessment in their international survey [11]. All older patients, from age 70-75, with cancer should be screened for frailty to streamline resource and time [5].…”

Section: Discussionmentioning

confidence: 96%

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Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Frélaut

Glas

Zapardiel

et al. 2019

Cancers

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Although a quarter of cervical cancers occur after the age of 65 years, there is no treatment consensus for these patients. The aim of this work was to survey how physicians treat patients with advanced cervical cancer, focusing on treatment adjustments according to age and frailty status. Specialists were invited to an online survey. Data collected included information on respondent and treatment strategy in four cases (FIGO IIb, FIGO IVa, FIGO IVb, metastatic recurrence) with three age scenarios (45-year-old, 75-year-old and fit, 75-year-old and unfit). We received 237 responses of which 117 were fully completed. Thirty-four percent of respondents reported they had available access to a geriatric team and 25% used a frailty screening tool in routine. Therapeutic strategies did not differ between young and old fit patients. However, treatment modalities and intensity were different for old and unfit patients. Physicians answered that they would treat old fit patients as their younger counterparts but would reduce treatment intensity for old unfit patients. However, even if they were willing to adapt their treatment strategy based on frailty status, most of them do not use the tools that would allow distinguishing “fit” and “unfit” older patients, leaving room for improving accurate geriatric evaluation.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 96%

Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Frélaut

Glas

Zapardiel

et al. 2019

Cancers

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“…Hamamoto et al reported that only 21% of institutions selected definitive chemoradiotherapy as a treatment method for patients aged 80 years or older with esophageal cancer, although 91% of institutions selected that treatment method for patients aged 75-79 years (8). In the present study, 79 (42.7%) out of the 185 patients received concurrent chemotherapy, and this higher proportion might be because all of the institutions that took part in this study were highvolume centers for esophageal cancer in Japan.…”

Section: Discussionmentioning

confidence: 99%

Is Concurrent Chemotherapy With Radiotherapy for Esophageal Cancer Beneficial in Patients Aged 80 Years or Older?

et al. 2019

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Background/Aim: To determine whether concurrent chemotherapy with radiotherapy should be performed in elderly patients with esophageal cancer. Patients and Methods: A total of 185 patients aged 80 years or older who were treated with definitive radiotherapy alone or combined with chemoradiotherapy for esophageal cancer at seven institutions were enrolled. In order to compare survival rates of patients treated with chemoradiotherapy with those of patients treated with radiotherapy alone, propensity score matching was performed to homogenize the two populations. Results: For the whole patient cohort, the 3-year overall survival (OS) rate was 52.6% and the median survival was 42.5 months. After propensity score matching, the 3-year OS rate for the chemoradiotherapy group was not significantly better than that for the group treated with radiotherapy alone (53.7% vs. 59.9%, p=0.876). Conclusion: Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older did not have significant OS benefit over radiotherapy alone. Esophageal cancer is the fifth most common cause of cancerrelated death worldwide for men and the eighth most common cause of cancer-related death worldwide for women (1). Since the Radiation Therapy Oncology Group (RTOG) 85-01 trial showed that the outcome of definitive chemoradiotherapy was significantly better than that of radiotherapy alone for patients with esophageal cancer (2), concurrent chemoradiotherapy has been a standard treatment for esophageal cancer. However, most patients aged 80 years or older are unlikely to be able to tolerate chemotherapy. There are about 4,000 patients aged 80 years or older with esophageal cancer in Japan every year. Miyata et al. reported that elderly patients aged 80 years or older who underwent surgery for esophageal cancer had a poorer prognosis than did younger patients because a smaller percentage of elderly patients received neoadjuvant therapy (3). They concluded that aggressive treatment may be recommended for elderly patients. Based on data from Surveillance, Epidemiology, and End Results (SEER), patients aged 80 years or older with esophageal cancer benefit from radiotherapy alone compared to no radiotherapy if the cancer is in a localized/regional stage (4). The results of analysis of data in a Japanese nationwide database showed that radiotherapy alone tended to be performed for elderly patients (5). There is no definitive evidence of a beneficial effect of concurrent chemotherapy with radiotherapy for elderly patients with esophageal cancer. The purpose of the present study was to determine whether concurrent chemotherapy with radiotherapy rather than radiotherapy alone should be administered to patients with esophageal cancer aged 80 years or older. Patients and Methods Patient eligibility. The eligibility criteria included i) histopathologically proven esophageal cancer; ii) clinical stage T1-4; N0-1; M0/M1 lym [International Union Against Cancer (UICC) 2002)] (6); iii) 80 or more years of age; iv) no history of rad...

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“…For patients with unresectable or medically inoperable EC, concurrent chemoradiotherapy (CRT) is considered an optimal alternative. Due to intolerance to the acute toxicities of standard CRT [4], most elderly patients require an altered treatment strategy. The efficacy of CRT in elderly patients with EC had not been established, due to conflicting and inconclusive results from previous studies [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Multicenter questionnaire survey on patterns of care for elderly patients with esophageal squamous cell carcinoma by the Japan Esophageal Oncology Group

Cited by 11 publications

References 24 publications

Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey

Is Concurrent Chemotherapy With Radiotherapy for Esophageal Cancer Beneficial in Patients Aged 80 Years or Older?

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

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