Toxicity and outcomes after chemoradiation for esophageal cancer in patients age 75 or older

• Published in: Diseases of the esophagus 2010-05, Vol.23 (4), p.316-323
• Main Authors: Mak, R. H., Mamon, H. J., Ryan, D. P., Miyamoto, D. T., Ancukiewicz, M., Kobayashi, W. K., Willett, C. G., Choi, N. C., Blaszkowsky, L. S., Hong, T. S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; chemotherapy; Combined Modality Therapy; elderly; esophageal cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - radiotherapy; Female; Humans; Male; radiation; Radiation Dosage; Radiotherapy - adverse effects; Retrospective Studies; toxicity
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2009.01014.x

SUMMARY Randomized trials of chemoradiation for esophageal cancer have included very few patients age ≥ 75. In this retrospective study, we describe the outcomes and toxicity of full‐dose chemoradiation in elderly patients with esophageal cancer. Patients, age ≥ 75, treated with full‐dose chemoradiation for esophageal carcinoma from 2002 to 2008 were retrospectively reviewed. Thirty‐four patients were identified with a median age of 79.5 (range 75–89). The median Eastern Cooperative Oncology Group performance status was 1 (range 0–3) and the median Adult Comorbidity Evaluation‐27 score was 1 (range 0–3). Twenty‐eight patients received definitive and six received neoadjuvant chemoradiation. The median radiation dose delivered was 50.4 Gray (range 3.6–68.4 Gray). Platinum‐based chemotherapy was used in 79.4% of patients. Fifty percent of the patients completed all planned radiation therapy (RT) and chemotherapy; 85.3% completed RT. Acute toxicity ≥ grade 4 occurred in 38.2% of patients, and 70.6% of the patients required hospitalization, emergency department visit, and/or RT break. Median follow‐up was 14.5 months among 7 survivors, and median survival was 12.0 months (95% confidence interval [CI]: 9.7 to 24.1 months). The actuarial overall survival at 2 years was 29.7% (95% CI: 16.6 to 52.6%). There were four treatment‐related deaths. The median time to any recurrence was 10.4 months. Nineteen patients had a local and/or distant recurrence. In conclusion, elderly patients experienced substantial morbidity from chemoradiation, and long‐term survival was low. Future efforts to improve treatment tolerability in the elderly are needed.