Advanced Age is Not a Contraindication for Treatment With Curative Intent in Esophageal Cancer. (September 2018)

• Record Type: Journal Article
• Authors: Voncken, Francine E.M.; van der Kaaij, Rosa T.; Sikorska, Karolina; van Werkhoven, Erik; van Dieren, Jolanda M.; Grootscholten, Cecile; Snaebjornsson, Petur; van Sandick, Johanna W.; Aleman, Berthe M.P.
• Is Part Of: American journal of clinical oncology. Volume 41:Number 9(2018)
• Publication Date: 2018-09
• Subjects: esophageal cancer -- chemoradiotherapy -- esophagectomy -- elderly -- survival; Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000390
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Objectives: The objective of this study is to compare long-term outcomes between younger and older (70 y and above) esophageal cancer patients treated with curative intent. Materials and Methods: Overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free interval were compared between older (70 y and above) and younger (below 70 y) esophageal cancer patients treated between 1998 and 2013. Treatment consisted of neoadjuvant chemoradiotherapy with surgery or definitive chemoradiotherapy: 36 to 50.4 Gy in 18 to 28 fractions combined with 5-fluorouracil/cisplatin or carboplatin/paclitaxel. Results: The study comprised 253 patients, of whom 76 were 70 years and older. Median age was 64 years (range, 41 to 83). Most patients had stage II-IIIA disease (83%). Planned treatment was neoadjuvant chemoradiotherapy with surgery for 169 patients (41 patients aged 70 y and older) and definitive chemoradiotherapy for 84 patients (31 patients aged 70 y and older). The compliance to radiotherapy was 92%, with no difference between older and younger patients. In 33 patients (13 patients aged 70 y and older) planned surgery was not performed. Median follow-up was 4.9 years. Three-year OS was 42%. The multivariable analysis showed no statistical difference in OS or in DFS comparing older and younger patients: OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.61-1.28), DFS (HR, 0.87; 95% CI, 0.60-1.25). Elderly showed a longer locoregional recurrence-free interval; HR, 0.53 (95% CI, 0.30-0.92; P =0.02) and a higher pathologic complete response rate (50% vs. 25%; P =0.02). Conclusions: Long-term outcomes of older esophageal cancer patients (70 y and above) selected for treatment with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy were comparable with the outcomes of their younger counterparts. Advanced age alone should not be a contraindication for potentially curative chemoradiotherapy-based treatment in esophageal cancer patients. Abstract : Supplemental Digital Content is available in the text.