Abstract
To evaluate treatment-related toxicity, treatment compliance, surgical complications and event-free survival (EFS) in older (≥70 years) versus younger (<70 years) adults who underwent perioperative treatment for gastric cancer. In the CRITICS trial, 788 patients with resectable gastric cancer were randomised before start of any treatmentand received preoperative chemotherapy (3 cycles of epirubicin, cisplatin or oxaliplatinand capecitabine), followed by surgery, followed by either postoperative chemotherapy or chemoradiotherapy (45Gy+cisplatin+capecitabine). 172 (22%) patients were older adults. During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger adults experienced severe toxicity (p<0.001); older adults received significantly lower relative dose intensities (RDIs) for all chemotherapeutic drugs. Equal proportions of older versus younger adults underwent curative surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications and postoperative mortality. Postoperative therapy after curative surgery started in 87 (64%) older adults versus 391 (78%) younger adults (p<0.001). Incidence of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults versus 113 (59%) in younger adults (p=0.541); older adults received significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) for younger adults (p=0.703), with comparable chemotherapy RDIs and radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger adults. Perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults compared with younger adults. As comparable proportions of patients underwent curative surgery, future studies should focus on neo-adjuvant treatment. ClinicalTrials.gov identifier: NCT00407186. EudraCT number: 2006-00413032.
Highlights
Gastric cancer is one of the leading causes of cancerrelated deaths worldwide [1]
World Health Organisation (WHO) performance status was slightly better in younger adults, and comorbidities were more frequently present in older adults
In this post-hoc analysis of the CRITICS trial, patient compliance of perioperative treatment for resectable gastric cancer was poorer in older adults compared with younger adults, especially in the postoperative phase
Summary
Gastric cancer is one of the leading causes of cancerrelated deaths worldwide [1]. In the Netherlands, the incidence of gastric cancer was 8.8 per 100,000 in 2018 [2]. A population-based study from Germany indicated that among 8601 gastric cancer diagnoses, 59% of the patients were 70 years or older [3]. Age has a significant influence on treatment choices in the management of resectable gastric cancer. The German population-based study included patients with all stages of gastric cancer; older adults were diagnosed in a slightly lower stage compared with younger adults, but they were less frequently operated, and surgery was less often combined with (neo-)adjuvant treatment [3]. Several studies have compared tolerability of treatment in older versus younger adults with gastric cancer. Randomised clinical trials have not provided detailed sub-analyses on older adults with resectable gastric cancer, information on tolerability of these treatments in older adults who were fit to undergo (neo-) adjuvant treatment are presently lacking
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