Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis
Abstract Background To analyse the outcome of elderly patients (≥70 years) with esophageal cancer treated with curative intent radio(chemo)therapy. Methods Fifty five patients (median 75 years) receiving curative intent radio(chemo)therapy for esophageal cancer from 1999 to 2015 were retrospectively...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Radiation Oncology |
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| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1044-8 |
| _version_ | 1818496348221079552 |
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| author | Franziska Walter David Böckle Nina-Sophie Schmidt-Hegemann Rebecca Köpple Sabine Gerum Stefan Boeck Martin Angele Claus Belka Falk Roeder |
| author_facet | Franziska Walter David Böckle Nina-Sophie Schmidt-Hegemann Rebecca Köpple Sabine Gerum Stefan Boeck Martin Angele Claus Belka Falk Roeder |
| author_sort | Franziska Walter |
| collection | DOAJ |
| description | Abstract Background To analyse the outcome of elderly patients (≥70 years) with esophageal cancer treated with curative intent radio(chemo)therapy. Methods Fifty five patients (median 75 years) receiving curative intent radio(chemo)therapy for esophageal cancer from 1999 to 2015 were retrospectively analyzed. Most patients showed locally advanced disease (T3/4:78%, N+:58%) with squamous cell histology (74%). Charlson comorbidity score was > 1 in 27%. 48 patients (87%) received definitive treatment while 7 patients were treated neoadjuvantly. RT was carried out as 3D-conformal treatment or IMRT. Concurrent chemotherapy was applied in 85%, mainly cisplatin/5-FU or mitomycin/5-FU. 18FDG-PET/CT staging was used in 65%. Results Median follow-up was 11 months (1–68) and 21 months in survivors. 1- and 2-year rates of LRC, DC, FFTF and OS were 60%/45, 81%/72, 55%/41 and 46%/26% for the entire cohort. In univariate analysis, addition of surgery was associated with improved LRC and FFTF, nodal involvement with improved DC and lower T stage, lower Charlson score and use of PET-CT with improved OS. In multivariate analysis, lower T stage and lower Charlson score remained significant for OS. Patients treated after 2008 showed a significantly improved FFTF (1-year FFTF 64% vs 35%) and OS (1-year OS 66% vs 24%). Maximum (chemo)radiation related grade3+ toxicity was observed in 80% including 7 deaths (13%). Grade5 toxicity was significantly associated with Charlson score (CS > 1:33% vs CS ≤ 1:5%) and treatment period (24% before vs 3% after 2008). The patients treated after 2008 included significantly more SCCs, less T4 stages, had a higher percentage of PET-CT staging and were treated with smaller field lengths. Trends were also observed for lower Charlson scores and increased use of IMRT. Conclusion Curative intent (chemo)radiation of elderly patients with esophageal cancer may result in considerable toxicity and unfavorable outcome. However, a clear improvement over time was observed in our cohort, probably based on improved patient selection. In patients with less advanced stages and lower comorbidity similar results as in younger cohorts seem achievable with modern staging and treatment approaches. Age per se should not be a decisive factor, but careful attention should be paid regarding patient selection including a structured and tight follow-up strategy. |
| first_indexed | 2024-12-10T18:32:07Z |
| format | Article |
| id | doaj.art-0f4a2659b1b843048747ecd2f82b16d7 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-10T18:32:07Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-0f4a2659b1b843048747ecd2f82b16d72022-12-22T01:37:54ZengBMCRadiation Oncology1748-717X2018-05-0113111210.1186/s13014-018-1044-8Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysisFranziska Walter0David Böckle1Nina-Sophie Schmidt-Hegemann2Rebecca Köpple3Sabine Gerum4Stefan Boeck5Martin Angele6Claus Belka7Falk Roeder8Department of Radiation Oncology, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichDepartment of Internal Medicine III, University Hospital LMU MunichDepartment of Surgery, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichDepartment of Radiation Oncology, University Hospital LMU MunichAbstract Background To analyse the outcome of elderly patients (≥70 years) with esophageal cancer treated with curative intent radio(chemo)therapy. Methods Fifty five patients (median 75 years) receiving curative intent radio(chemo)therapy for esophageal cancer from 1999 to 2015 were retrospectively analyzed. Most patients showed locally advanced disease (T3/4:78%, N+:58%) with squamous cell histology (74%). Charlson comorbidity score was > 1 in 27%. 48 patients (87%) received definitive treatment while 7 patients were treated neoadjuvantly. RT was carried out as 3D-conformal treatment or IMRT. Concurrent chemotherapy was applied in 85%, mainly cisplatin/5-FU or mitomycin/5-FU. 18FDG-PET/CT staging was used in 65%. Results Median follow-up was 11 months (1–68) and 21 months in survivors. 1- and 2-year rates of LRC, DC, FFTF and OS were 60%/45, 81%/72, 55%/41 and 46%/26% for the entire cohort. In univariate analysis, addition of surgery was associated with improved LRC and FFTF, nodal involvement with improved DC and lower T stage, lower Charlson score and use of PET-CT with improved OS. In multivariate analysis, lower T stage and lower Charlson score remained significant for OS. Patients treated after 2008 showed a significantly improved FFTF (1-year FFTF 64% vs 35%) and OS (1-year OS 66% vs 24%). Maximum (chemo)radiation related grade3+ toxicity was observed in 80% including 7 deaths (13%). Grade5 toxicity was significantly associated with Charlson score (CS > 1:33% vs CS ≤ 1:5%) and treatment period (24% before vs 3% after 2008). The patients treated after 2008 included significantly more SCCs, less T4 stages, had a higher percentage of PET-CT staging and were treated with smaller field lengths. Trends were also observed for lower Charlson scores and increased use of IMRT. Conclusion Curative intent (chemo)radiation of elderly patients with esophageal cancer may result in considerable toxicity and unfavorable outcome. However, a clear improvement over time was observed in our cohort, probably based on improved patient selection. In patients with less advanced stages and lower comorbidity similar results as in younger cohorts seem achievable with modern staging and treatment approaches. Age per se should not be a decisive factor, but careful attention should be paid regarding patient selection including a structured and tight follow-up strategy.http://link.springer.com/article/10.1186/s13014-018-1044-8ElderlyEsophageal cancerChemoradiation |
| spellingShingle | Franziska Walter David Böckle Nina-Sophie Schmidt-Hegemann Rebecca Köpple Sabine Gerum Stefan Boeck Martin Angele Claus Belka Falk Roeder Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis Radiation Oncology Elderly Esophageal cancer Chemoradiation |
| title | Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis |
| title_full | Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis |
| title_fullStr | Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis |
| title_full_unstemmed | Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis |
| title_short | Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis |
| title_sort | clinical outcome of elderly patients ≥ 70 years with esophageal cancer undergoing definitive or neoadjuvant radio chemo therapy a retrospective single center analysis |
| topic | Elderly Esophageal cancer Chemoradiation |
| url | http://link.springer.com/article/10.1186/s13014-018-1044-8 |
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