Perioperative Therapy with Postoperative Chemoradiotherapy in the Critics Gastric Cancer Trial: A Comparison of Elderly Versus Non-Elderly Patients

Abstract

Patient compliance of postoperative chemoradiotherapy (CRT) for gastric cancer is poor. Elderly patients may be at particularly risk. Here, we present a subgroup analysis focusing on the CRT arm of the CRITICS phase III trial, comparing elderly with non-elderly patients. Patients with resectable gastric cancer or gastro-esophageal cancer with tumor bulk in the stomach, were treated with 3 cycles of preoperative chemotherapy (CT) (epirubicin, cisplatin/oxaliplatin, and capecitabine), resection with D2 lymph node dissection and postoperative CRT (45Gy + cisplatin + capecitabine). Elderly patients were defined as those aged ≥70 years at time of randomization. We present tolerability and outcomes, including relative dose intensities (RDIs) with interquartile range (IQR) for elderly versus non-elderly patients. A total of 172 (22%) out of 788 were elderly patients. Median age was 73 years (range 70-82) for elderly patients and 59 years (range 28-69) for non-elderly patients; 104 (60%) versus 249 (40%) had comorbidities (p<0.001). Median start doses for preoperative CT were similar in both groups. Preoperatively, elderly patients experienced significantly more severe (grade 3-5) toxicities: 131 (77%) versus 380 (62%) (p<0.001). All chemotherapy RDIs were lower for elderly patients compared to non-elderly patients (p<0.001); 120 (70%) elderly patients versus 535 (88%) finished preoperative chemotherapy (p<0.001). A total of 137 (80%) elderly and 499 (81%) non-elderly patients underwent curative resection (p=0.941), of whom 14 (11%) versus 53 (11%) had an R1 resection (n=9 unknown; p=0.947) and 111 (84%) elderly patients versus 433 (88%) non-elderly patients had a lymph node D2 resection or more (n=14 unknown; p=0.188). Among patients who were randomized to postoperative CRT, 46 (54%) elderly patients and 199 (64%) non-elderly patients started CRT; more details about postoperative chemoradiotherapy are displayed in the table. Age had a significant impact on completing preoperative CT, with elderly patients having more toxicities and lower RDIs compared to non-elderly patients. Although less elderly patients started postoperative CRT, this part of the treatment was tolerated similarly in elderly versus non-elderly patients. Hence, age alone should not be the reason to withhold patients from postoperative CRT.Abstract 2483; Table 1VariableElderly patientsN=46Non-elderly patientsN=199P valueSevere (grade 3-4) toxicity22 (48%)89 (45%)0.828Median RT dose (Gy; median; IQR)45 (45-45)45 (45-45)0.126Cisplatin (RDI; IQR)97% (78-99%)98% (80-100%)0.437Capecitabine (RDI; IQR)87% (69-100%)91% (80-100%)0.249Completed CRT35 (76%)167 (84%)0.204 Open table in a new tab