Outcomes from a Single Institution Cohort of 248 Patients with Stage I-III Esophageal Cancer Treated with Radiotherapy: Comparison of the Younger and Elderly Populations

Abstract

Purpose: In the absence of metastases, individual management of esophageal cancer (EC) is variable based on various tumour and patient factors. Combinations of radiotherapy, chemotherapy and surgery are often used. Specifically, age is often a large determinate on the management of EC. Outcomes for all patients receiving radiotherapy for non-metastatic EC, as well as comparing the elderly population (defined as 75 years of age and older) to the younger population (defined as less than 75 years of age) at a single institution were assessed. Methods: A retrospective cohort of all consecutive patients treated with radiotherapy doses >40Gy for stage I-III EC between 2010 and 2018 was identified after submission to the local institutional research ethics board. Outcomes were analyzed using descriptive statistics, Kaplan-Meier estimates and Cox proportional hazards regression. Results: Among the 248 identified patients, 70.1% of patients had adenocarcinoma, with a median tumour length of 6cm. Most (79%) tumours were identified in the distal third of the esophagus, and 59.3% of patients had clinically node positive disease at presentation. 69 patients (28%) were identified as elderly. Tumour characteristics were similar in both groups, with the exception of an increased proportion of squamous cell carcinoma (27.6%) in the elderly, compared with 14.5% in the younger population (p<0.001). Trimodality treatments were completed by 116 patients overall; specifically, 104 (58.1%) and 12 (17.4%) patients in the younger and elderly populations, respectively. Median overall survival for all patients was 20.3 months. For patients completing trimodality treatment, median survival was 40.2 months and 33.7 months for the younger and elderly patient groups, respectively. In the elderly population, improved survival was seen on multivariate analysis, independent of treatment received, in patients who had a heart V30Gy under 46%. Conclusions: Clinical outcomes in the treatment of EC vary significantly by treatment approach, with the most favourable results in those receiving trimodality therapy. This is seen in both the younger and elderly populations. These results suggest that there is a role for trimodality treatment in well-selected elderly patients with EC. Furthermore, careful review of the heart dose is important, as it may be a factor in overall survival, specifically in the elderly population.