Abstract
Background: Although the prevalence of esophageal cancer increases in elderly patients, its clinical history and outcome after treatment remain poorly described.Methods: Between January 2001 and December 2011, 58 patients (pts) older than 75 years received 3D-conformal radiotherapy (mean dose 51 Gy) in two French cancer centers. 47/58 (82%) patients received concomitant chemotherapy (with CDDP and/or FU regimens) and 8 patients underwent surgery after primary radiochemotherapy (RCT).Results: Median age was 77.9 years and the performance status (PS) was 0 or 1 in 89%. Tumors were mainly adenocarcinoma of lower esophagus or gastroesophageal junction (n = 51, 89%), T3T4 (n = 54, 95%), and N1 (n = 44, 77%). The mean follow-up was 21.9 months. In the overall population, the median progression-free survival was 9.6 months and median overall survival (OS) was 14.5 months. Using univariate analysis, OS was significantly associated with age (p = 0.048), PS (p < 0.001), and surgery (p = 0.035). 35 (60.3%) and 18 patients (31%) experienced grade 1–2 or 3–4 toxicity, respectively (CTCAE v4.0).Conclusion: Radiochemotherapy in elderly patients is a feasible treatment and its outcome is close to younger patient’s outcome published in the literature. Surgical resection, after comprehensive geriatric assessment, should be recommended as the standard treatment for adenocarcinoma of lower esophagus or gastroesophageal junction in elderly patients with good PS and low co-morbidity profile, as it is in younger patients.
Highlights
Esophageal cancer (OC) is the eighth most common cancer worldwide, with 481,000 new cases (3.8% of the total) estimated in 2008, and the sixth most common cause of death from cancer with 406,000 deaths (5.4% of the total) [1]
overall survival (OS) was significantly associated with age (p = 0.048), performance status (PS) (p < 0.001), and surgery (p = 0.035). 35 (60.3%) and 18 patients (31%) experienced grade 1–2 or 3–4 toxicity, respectively (CTCAE v4.0)
After comprehensive geriatric assessment, should be recommended as the standard treatment for adenocarcinoma of lower esophagus or gastroesophageal junction in elderly patients with good PS and low co-morbidity profile, as it is in younger patients
Summary
Esophageal cancer (OC) is the eighth most common cancer worldwide, with 481,000 new cases (3.8% of the total) estimated in 2008, and the sixth most common cause of death from cancer with 406,000 deaths (5.4% of the total) [1]. The incidence of OC in elderly patients has rapidly increased in the Western countries over the past 25 years, with a specific mortality increasing with age [4]. The field of OC management improved in several ways: (i) demonstration that the dose of 50 Gy seemed to be the better option [5], (ii) evidence from meta-analysis in favor of neoadjuvant chemotherapy or chemoradiotherapy [6], and (iii) the demonstration of the good efficacy – safety balance in favor of FOLFOX regimen (5-FU and Oxaliplatin) when compared with usual 5-FU-CDDP (Cisplatin) [7] None of these trials presented sub-group data analysis focused on elderly patients. The prevalence of esophageal cancer increases in elderly patients, its clinical history and outcome after treatment remain poorly described
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