Elderly Esophageal Cancer Patients Research Articles

Response to Concurrent Chemoradiotherapy as a Prognostic Marker in Elderly Patients with Locally Advanced Esophageal Cancer

Little is known about chemoradiotherapy in elderly patients with locally advanced esophageal cancer. We compared the efficacy and toxicity of chemoradiotherapy in elderly and non-elderly patients with locally advanced esophageal cancer and determined the variables affecting the treatment outcome in the elderly patients with locally advanced esophageal cancer who had received chemoradiotherapy. Fifty-seven elderly patients (age ≥ 65 years) and 30 non-elderly patients (age <65 years) were reviewed retrospectively. The median age of the elderly group was 69 years and in the non-elderly group, 56.5 years. Although treatment compliance appeared to be poor, the response rate and median survival were similar in both the groups (elderly versus non-elderly; 84.4% vs 87.5%, and 11.2 months vs 11.3 months) and so were G3/4 hematologic and non-hematologic toxicities. The treatment-related mortality of the elderly patients appeared to be higher than that of the non-elderly group (7.0% vs 3.3%), but did not reach statistical significance. In prognostic factor analysis, a major response to chemoradiotherapy was a good prognostic indicator in the elderly group (response versus non-response; median overall survival times of 19.5 vs 5.4 months, respectively, P <0.001). The study suggests that chemoradiotherapy for locally advanced esophageal cancer in elderly patients, even though treatment compliance appears to be poor, is as safe and effective as in non-elderly patients and that the response to chemoradiotherapy is related to prognosis in elderly patients.

高齢者に対する外科的治療&amp;mdash;食道&amp;mdash;

高齢者に対する外科的治療&amp;mdash;食道&amp;mdash;

Multimodal treatment for esophageal cancer in elderly patients

Multimodal treatment for esophageal cancer in elderly patients

Esophagectomy in Elderly Patients With Esophageal Cancer

The number of elderly patients who undergo surgery for esophageal cancer is increasing as a result of longer life expectancy, but little is known about the morbidity and outcome of such procedures in the elderly. This study compared the results of surgery for evaluating the effect of age on esophageal cancer patients. Patients who underwent surgery with curative intent for esophageal cancer from January 1999 to July 2009 were included in this retrospective study. Data were compared between patients ≥70 years (elderly group) and patients <70 years old (younger group). Patient characteristics, hospital course, surgical mortality, morbidity, and survival were compared between patients in these two age groups. Of the 166 patients included, 35 (21.1%) were at least 70 years old (mean age, 75.2 years) and 131 (78.9%) were younger than 70 years old (mean age, 51.8 years). All 29 eligible elderly and 29 randomly selected, age-adjusted younger patients were included for a balanced comparison. The elderly group had significantly longer hospital stays (46 vs. 22 days) and a significantly higher incidence of surgical morbidity (51.7% vs. 20.7%). Cardiopulmonary-related complications were the main causes of operative morbidity in the elderly group. The elderly group also had higher performance state scores. On the basis of less adjuvant anticancer treatment received, the overall survival of elderly patients was comparable to their younger counterparts (12.1 vs. 12.7 months; p = 0.77). The results of this study suggest that curative surgery for esophageal cancer in elderly patients may result in comparable overall survival and greater, but acceptable, morbidity in comparison with younger patients. Our data suggest that age ≥70 years old should not be considered a counterindicator for curative surgery in esophageal cancer patients.

Evaluation of chemoradiotherapy for elderly esophageal cancer patients

15613 Background: Radiotherapy based treatments are less invasive than radical surgery and are attractive for elderly patients. Concurrent chemoradiotherapy(CRT) outperforms radiotherapy alone(RT) ...

Results of esophagectomy for esophageal cancer in elderly patients: Age has little influence on outcome and survival

The aging of the population and a longer life expectancy have led to an increased number of elderly patients with esophageal cancer being referred for surgical treatment. The aim of this study was to assess the effects of age on the outcome of surgery for esophageal cancer at a single institution. Perioperative outcome and long-term survival of patients at least 70 years old undergoing esophagectomy between 1992 and 2005 for cancer of the esophagus or esophagogastric junction were compared with findings in younger patients. Patients who underwent an abdominal procedure only were excluded from the analysis. The analysis considered 580 patients younger than 70 years and 159 at least 70 years old. Clinical presentation in the two groups was similar, as were postoperative morbidity and mortality, despite significant differences in perioperative risk factors. Irrespective of age, overall survival was 34% at 5 years for all patients and 37% for patients with R0 resection. Increased experience and refinements in perioperative care explain the better results of esophagectomy in elderly patients in recent years. Short- and long-term outcomes after esophagectomy for carcinoma in patients older than 70 years are comparable with those of their younger counterparts. Advanced age per se thus should not be considered a contraindication to esophageal resection.

Radiation therapy for elderly esophageal cancer patients; results of the patterns of care study in japan

Radiation therapy for elderly esophageal cancer patients; results of the patterns of care study in japan

Radiation therapy for elderly esophageal cancer patients; results of the patterns of care study in japan

Radiation therapy for elderly esophageal cancer patients; results of the patterns of care study in japan

Three-field lymph node dissection for esophageal cancer in elderly patients over 70 years of age

Background. The risk and benefit of esophagectomy with three-field lymph node dissection has not been well defined in elderly esophageal cancer patients. Methods. A total of 441 patients underwent three-field lymph node dissection from 1986 to 1998. Patients were divided into two age groups: group 1 consisted of 79 patients aged 70 years or over, and group 2 consisted of 362 patients under 70 years of age. Patients’ characteristics and surgical outcomes were compared between groups. Risk factors for morbidity, mortality, and survival of patients in group 1 were further studied by multivariate analysis. Results. Significantly more patients had multiorgan dysfunction preoperatively in group 1 (24; 30.4%) than in group 2 (34; 9.4%, p < 0.001). The overall (65.8% vs 61.6%, p = 0.483) and surgically related complication rates (41.8% vs 52.2%, p = 0.093) were similar, but significantly more organ failure (11.4% vs 5.0%, p = 0.031) and infection (22.8% vs 13.8%, p = 0.045), defined as medical complications, occurred in group 1. There was no significant difference in 30-day (3.8% vs 0.8%, p = 0.074) or in-hospital mortality (7.6% vs 3.3%, p = 0.082) between groups. The overall (40.9% vs 48.1%, p = 0.235) and cause-specific 5-year survivals (55.4% vs 59.1%, p = 0.688) were comparably good in both groups, but the risk of death due to causes other than esophageal cancer was much higher in the elderly ( p = 0.028). Multiorgan dysfunction was an independent predictive factor in elderly patients for overall and medical morbidity, overall survival, and risk of death from causes other than esophageal cancer. Conclusions. Esophagectomy with three-field lymph node dissection could be carried out safely in patients over 70 years of age with satisfactory long-term results. For elderly patients with multiorgan dysfunction, however, less invasive procedures might be more appropriate.

Three Elderly Patients With Lower Esophageal Cancer Successfully Treated By Transhiatal Esophagectomy Assisted by Mediastinoscopy

Mediastinoscopy-assisted transhiatal esophagectomy recently has been applied in patients with intrathoracic esophageal cancer. Elderly patients with esophageal cancer experience several types of complications and often cannot undergo standard transthoracic esophagectomy. In this study, three elderly patients with preoperative complications underwent mediastinoscopy-assisted transhiatal esophagectomy for esophageal cancer located in the lower part of the esophagus. Patient 1 was an 80-year-old man with alcoholic liver cirrhosis. Patient 2 was a 78-year-old man with bronchial asthma. Patient 3 was an 81-year-old-man with diabetes mellitus and an atherosclerotic obstruction of the lower extremities. In these patients, mediastinoscopy-assisted transhiatal esophagectomy concomitant with reconstruction by means of a gastric tube was performed. Lymph node dissections of the middle and lower mediastinum and of the abdomen, including the regions surrounding the left gastric and celiac arteries, were performed. Postoperative complications developed only in patient 1; minor leakage of the esophagogastrostomy and high bilirubinemia were observed. Metastasis was detected in the lymph nodes surrounding the celiac artery in patient 1 and surrounding the left gastric artery in patients 2 and 3. Patient 2 died of pneumonia 18 months later, but the other patients have been well, without recurrence of the cancer after surgery. In conclusion, mediastinoscopy-assisted transhiatal esophagectomy has some benefits for elderly esophageal cancer patients who experience preoperative complications.

Surgery for esophageal cancer in elderly patients: The view from Nottingham

Objective: Our aim was to compare the outcome of esophageal resection for carcinoma in elderly patients (aged over 70 and over 80 years) with that of younger patients managed within a single specialist thoracic surgery unit. Patients and methods: Between January 1987 and November 1997, 523 patients underwent esophagectomy for carcinoma in the Nottingham City Hospital Thoracic Surgery Unit. The patients were divided into 3 groups by age: group I, under 70 years ( n = 337); group II, 70 to 79 years ( n = 150), and group III, 80 to 86 years ( n = 36). These groups were compared with regard to preoperative medical status, operability and resectability, complications, operative mortality, and long-term survival. Results: Patients in groups II (6.0%) and III (2.8%) had fewer preexisting respiratory problems than patients in group I (12.5%), and the patients in group III had fewer preexisting cardiovascular problems (16.7%) than patients in groups I (25.2%) and II (32.7%). Although patients in group III were generally less likely to have operable lesions (64.3%), no significant differences in resectability rate were detected among the 3 groups (80.8%, 77.7%, and 80%). Elderly patients (groups II and III) had a higher incidence of overall (34% and 36.1%), respiratory (24.7% and 19.4%), and cardiovascular (7.3% and 11.1%) complications than those aged under 70 years (24.6%, 16.3%, and 2.1%, respectively). However, operative mortality (4.7%, 6.7%, and 5.6%) and 5-year survivals inclusive of operative mortality (25.1%, 21.2%, and 19.8%) were similar among the 3 groups. Conclusions: Accumulated experience in all aspects of perioperative management may account for a low hospital mortality in elderly patients despite a greater operative risk. The survival benefit is similar to that in the younger age groups, enforcing the view that esophagectomy within specialist thoracic units can be safely offered (in appropriately selected patients) with acceptable long-term survival in all age groups. (J Thorac Cardiovasc Surg 1998;116:545-53)

Mitchiner memorial lecture. Wellington, Napoleon and the medical services.

Background/Aim: The standard of treatment for esophageal cancer with adjacent organ invasion (T4) has not been established. We retrospectively analyzed the clinical outcomes of radiotherapy (RT) in elderly and younger patients with T4 esophageal cancer. Patients and Methods: Sixty-nine patients with T4 esophageal cancer who underwent RT at the Kanagawa Cancer Center between January 2014 and November 2020 were included in this study. Patients aged ≥70 years were defined as the elderly group and those aged &lt;70 years were defined as the younger group. The total dose of RT was set at 60 Gy in 30 fractions. Chemotherapy combined with 5-fluorouracil and cisplatin was administered concurrently with RT in general. The overall survival (OS) rate was estimated using the Kaplan–Meier method. Adverse events were assessed using CTCAE v4.0. Results: The median survival time (MST) of the elderly group (n=35) was 21.5 months, and the OS rates at 1, 3, and 5 years were 63.7%, 31.3%, and 15.6%, respectively. The MST of the younger group (n=34) was 12.5 months, and the OS rates at 1, 3, and 5 years were 52.2%, 29.4%, and 29.4%, respectively. No significant difference in OS was observed between the two groups (p=0.767). Toxicities were not significantly different between the two groups except for thrombocytopenia and esophageal fistula (p=0.012 and p=0.022, respectively). Conclusion: The clinical outcomes of RT for T4 esophageal cancer in elderly patients were generally similar to those in the younger group.