Comparison of radiotherapy alone versus concurrent chemoradiotherapy in the treatment of elderly esophageal cancer

Abstract

Objective To compare the prognostic factors and adverse effects of elderly patients with esophageal cancer between radiotherapy alone and concurrent chemoradiotherapy. Methods A total of 479 patients with esophageal squamous cell carcinoma aged 70 years or older were analyzed retrospectively at our institute, from January 2008 to December 2017. The patients were divided into radiotherapy alone group (359 cases) and concurrent chemoradiotherapy group (120 cases). After Propensity Score Matching (PSM), data from matched patients with 102 cases in each group was analyzed. The overall survival (OS) rates, the prognostic factors and adverse effects were assessed. Results The 1, 3, 5-year of OS in radiotherapy alone group after PSM were 77.4%, 40.1%, 22.7%, respectively, and median overall survival time (mOS) was 26.9 months (95% CI: 18.7-35.2 months). The chemoradiotherapy group after PSM were 79.5%, 47.6%, 35.7% and 35.6 months (95% CI: 23.2-48.0 months), respectively, while there was no significant difference between the groups (P>0.05). Subgroup analysis showed that the 1, 3, 5-year of OS and mOS of the patients aged 70-75 years in radiotherapy alone group were 79.4%, 41.0%, 26.2% and 29.2 months, respectively. The patients aged 70-75 years in chemoradiotherapy group were 86.5%, 56.1%, 47.6% and 48.9 months, respectively. There was statistically significance between the groups after PSM(χ2 =4.746, P<0.05). The univariate prognostic analysis showed that the age, T stage, N stage, clinical stage, short-term efficacy and performance status were influencing factors for OS (χ2=6.714-42.900, P<0.05). The clinical stage and short-term efficacy were independent prognostic factors for OS (χ2=5.007-9.181, P<0.05). In addition, the risk of non-tumor related death of the patients aged 75 years or older in the chemoradiotherapy group was higher than those in the radiotherapy alone group(χ2=5.630, P<0.05). The prevalence of toxicities (≥grade 3) including bone marrow suppression, radiation esophagitis and radiation pneumonia in the chemoradiotherapy group were higher than that in the radiotherapy alone group (χ2=4.701-28.318, P<0.05). Conclusions Concurrent chemoradiotherapy, compared with radiotherapy alone, may improve the prognosis of patients aged 70-75 years with esophageal squamous cell carcinoma. Key words: Esophageal cancer; Radiotherapy; Concurrent chemoradiotherapy; Prognosis