Prognostic analysis of radical 3 DRT ± chemotherapy in patients with esophageal cancer aged 70years or older

Abstract

Objective To evaluate the efficacy and adverse effects of radical three-dimensional conformal radiotherapy (3DRT)alone or combined with chemotherapy in elderly patients (≥70 years)with esophageal cancer. Methods The clinical data of 116 esophageal cancer patients who were aged 70 years or older and received radical 3 DRT ± chemotherapy from 2008 to 2013 were retrospectively analyzed. Of the 116 patients, 32 received concurrent chemoradiotherapy, 24 received sequential chemoradiotherapy, and 60received radiotherapy alone. Overall survival(OS)and progression-free survival(PFS)rates were determined using the Kaplan-Meier method, and survival difference analysis and univariate prognostic analysis was performed using the log-rank test. Multivariate prognostic analyses were performed using the Cox proportional hazard model. Results The follow-up rate was 100%. The 2-and 3-year sample sizes were 102 and 77, respectively. The 1-, 2-, and 3-year OS rates were 59.1%, 38.4%, and 23.2%, respectively, and the PFS rates were 61.9%, 37.9%, and 0%, respectively. The median OS for the patients treated with concurrent chemoradiotherapy, sequential chemoradiotherapy, and radiotherapy alone were 22.3, 18.0, and 12.4 months, respectively (P=0.044). The median OS was significantly different between patients treated with 60 Gy and 60 Gy (24.7 vs. 18.7 months, P=0.938). Multivariate analysis indicated that sex, presence or absence of combined chemotherapy, and radiotherapy dose were independent influencing factors for OS (P=0.003, 0.042, and 0.037, respectively) . Conclusions Radical 3 DRT ± chemotherapy are well tolerated in elderly patients with esophageal cancer and equally effective as in those younger than 70 years. Patients treated with radical concurrent chemoradiotherapy have a better prognosis than those treated with sequential chemoradiotherapy and radiotherapy alone. Radiotherapy with a dose of 60 Gy effectively improves the survival compared with doses less than 60 Gy, which suggests that 60 Gy is the optimal dose in radiotherapy. Key words: Esophageal neoplasms / radiochemtherapy; Radiotherapy, three - dimensional; Radiochemtherapy, concurrent; Radiochemtherapy, sequential; Prognosis