Outcomes by treatment modality in elderly patients with localized gastric and esophageal cancer.

Akina Natori ,Elena Elimova ,James Conner ,Li Ma ,Carol J Swallow ,Sara Hafezi-Bakhtiari ,James D Brierley ,Jennifer J Knox ,Patrik Rogalla ,E Chen ,Rebecca Wong ,G Liu ,Hao‐Wen Sim ,J Kim ,Daniel Yokom ,Savtaj Brar ,Gail Darling ,Bryan Chan ,Jolie Ringash ,Raymond Woo-Jun Jang

doi:10.3747/co.25.4208

Abstract

We aimed to assess current treatment patterns and outcomes in elderly patients with localized gastric and esophageal (ge) cancers. This retrospective analysis considered patients 75 years of age or older with ge cancers treated during 2012-2014. Patient demographics and tumour characteristics were collected. Overall survival (os) and disease-free survival were assessed by univariable and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors affecting treatment choices. The 110 patients in the study cohort had a median age of 81 years (range: 75-99 years). Primary disease sites were esophageal (55%) and gastric (45%). Treatment received included radiation therapy alone (29%), surgery alone (26%), surgery plus perioperative therapy (14%), chemoradiation alone (10%), and supportive care alone (14%). In multivariable analyses, surgery (hazard ratio: 0.48; 95% confidence interval: 0.26 to 0.90; p = 0.02) was the only independent predictor for improved os. Patients with a good Eastern Cooperative Oncology Group performance status (p = 0.008), gastric disease site (p = 0.02), and adenocarcinoma histology (p = 0.01) were more likely to undergo surgery. At our institution, few patients 75 years of age and older received multimodality therapy for localized ge cancers. Outcomes were better for patients who underwent surgery than for those who did not. To ensure optimal treatment selection, comprehensive geriatric assessment should be considered for patients 75 years of age and older with localized ge cancers.

Highlights

In part because of an aging population, the incidence of cancer is expected to increase by 67% in people 65 years of age and older from 2010 to 20301
To ensure optimal treatment selection, comprehensive geriatric assessment should be considered for patients 75 years of age and older with localized ge cancers
26% of patients are 75 years of age or older when they are diagnosed with cancer[6], and yet only 10% of that group of patients is enrolled into U.S National Cancer Institute a These authors contributed to the present work

Summary

Introduction

In part because of an aging population, the incidence of cancer is expected to increase by 67% in people 65 years of age and older from 2010 to 20301. Cancer is typically a disease of the elderly, no cut-off age has been universally accepted for defining “elderly,” 65 years is the accepted age in most high-income countries. Despite the increasing incidence and prevalence of cancer among elderly individuals, that population has been underrepresented in clinical trials[3,4,5]. TREATMENT OF GASTROESOPHAGEAL PATIENTS 75 YEARS OF AGE AND OLDER, Natori et al. We aimed to assess current treatment patterns and outcomes in elderly patients with localized gastric and esophageal (ge) cancers

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