Definitive Chemoradiotherapy for Esophageal Cancer in the Elderly : Clinical Outcomes for Patients Exceeding 80 years old
Menée auprès de trois cohortes incluant au total 280 patients atteints d'un cancer de l'œsophage, cette étude évalue, du point de vue du taux de survie sans récidive et du taux de survie globale, l'efficacité d'une chimioradiothérapie chez les patients âgés de 80 ans et plus
Purpose : The optimal treatment approach for patients≥80 years (“elderly”) with esophageal cancer is not well established. We assessed the clinical outcomes of elderly patients treated with definitive chemoradiotherapy (CCRT) at our institution. Methods and materials : 56 consecutive patients ≥80 years with esophageal cancer treated with conventional CCRT between 2001 and 2016 were propensity score matched 1:2 to generate two younger patient cohorts treated with CCRT without surgery (“Intermediate”, 65-79 years; n=112, and “Younger” <65 years; n=112). Treatment related toxicity was assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. The rates of overall survival (OS) and recurrence free survival (RFS) were calculated with the Kaplan-Meier method. Results : The median age of the 3 cohorts were 81 years (elderly, 80-92 years), 71 years (intermediate, 65-79 years), and 58 years (younger, 20-64 years). The elderly cohort was more likely to have cardiac comorbidities. While the cCR rate deviated significantly among the three cohorts, (78%, 72% and 56% with P=0.004), the data failed to identify statistically significant differences among RFS, 2- and 5-year OS, nor in median survival, which was 15.5 months, 23.6 months, and 20.2 months (P=0.468), respectively. The overall severe toxicity rate were 38%, 32%, and 30%, respectively (P=0.644), including comparable rate of radiation pneumonitis (P>0.05). The elderly cohort, however, did exhibit statistically significant evidence of an increased rate of severe radiation pneumonitis (≥ grade 3) which was observed to be 11% vs. 4% and 0%, respectively (P=0.003). Conclusions : The studied elderly population exhibited evidence of similar long-term clinical efficacy following definitive CCRT when compared to cohorts of younger patients with similar prognostic status. An increased rate of pulmonary toxicity was identified, without evidence of differences for non-pulmonary severe adverse events. Understanding prognostic risk factors of pulmonary toxicity following CCRT may effectuate improved long-term outcomes for elderly population.