Trimodality therapy vs definitive chemoradiation in older adults with locally advanced esophageal cancer
Menée à l'aide de données 2004-2017 des registres américains des cancers portant sur 1 901 patients âgés atteints d'un cancer de l'oesophage de stade localement avancé (âge : 66-79 ans), cette étude analyse l'efficacité, du point de vue de la mortalité globale, de la mortalité spécifique et des évènements indésirables, d'une thérapie trimodale par rapport à une chimioradiothérapie définitive
The comparative effectiveness of trimodality therapy versus definitive chemoradiation for treating locally advanced esophageal cancer in older adults is uncertain. Existing trials lack generalizability to older adults, a population with heightened frailty. We sought to emulate a hypothetical trial comparing these treatments using real world data.A cohort of adults 66-79 years of age diagnosed with locally advanced esophageal cancer between 2004-2017 was identified in the Surveillance Epidemiology and End Results-Medicare database. The clone-censor-weight method was leveraged to eliminate time-related biases when comparing outcomes between treatments. Outcomes included overall mortality, esophageal cancer-specific mortality, functional adverse events, and healthy days at home.1,240 individuals with adenocarcinomas and 661 with squamous cell carcinomas were identified. For adenocarcinomas, the standardized five-year risk of mortality was 73.4% for trimodality therapy and 83.8% for definitive chemoradiation (RR = 0.88, 95% CI: 0.82 to 0.95). Trimodality therapy was associated with mortality risk reduction for squamous cell carcinomas (RR = 0.87, 95% CI: 0.70 to 1.01). The one-year incidence of functional adverse events was higher in the trimodality group (adenocarcinomas RR = 1.40, 95% CI: 1.22 to 1.65; squamous cell carcinomas RR = 1.21, 95% CI: 1.00 to 1.49). Over five years, trimodality therapy was associated with 160 (95% CI: 67 to 229) and 177 (95% CI: 51 to 313) additional home days in individuals with adenocarcinomas and squamous cell carcinomas, respectively.Compared to definitive chemoradiation, trimodality therapy was associated with reduced mortality, but increased risk of function-related adverse events. Discussing these tradeoffs may help optimize care plans.
JNCI Cancer Spectrum 2022