Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer

Abstract Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive ra...

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Main Authors: Yong‐Chun Zhou, Li‐Li Chen, Hong‐Bo Xu, Qian Sun, Qi Zhang, Han‐Fei Cai, Hao Jiang
Format: Article
Language:English
Published: Wiley 2018-05-01
Series:Cancer Medicine
Subjects:
Online Access:https://doi.org/10.1002/cam4.1456
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author Yong‐Chun Zhou
Li‐Li Chen
Hong‐Bo Xu
Qian Sun
Qi Zhang
Han‐Fei Cai
Hao Jiang
author_facet Yong‐Chun Zhou
Li‐Li Chen
Hong‐Bo Xu
Qian Sun
Qi Zhang
Han‐Fei Cai
Hao Jiang
author_sort Yong‐Chun Zhou
collection DOAJ
description Abstract Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive radiotherapy (RT) for very elderly EC patients. We retrospectively analyzed 149 very elderly EC patients consecutively treated between January 2015 and June 2016 by definitive intensity‐modulated radiotherapy (IMRT) with or without chemotherapy. The clinical outcome and toxicities were assessed, and the potential prognostic factors, such as nutritional risk index (NRI) and neutrophil–lymphocyte ratio (NLR), were analyzed statistically. The median follow‐up time for survivors was 22.5 months. The 2‐year overall survival (OS), local–regional failure‐free survival (LRFFS), and distant metastasis‐free survival (DMFS) were 51.6%, 54.7%, and 85.2%, respectively. Independent predictors for poorer OS were higher American Joint Committee on Cancer (AJCC) stage, lower NRI, and higher NLR value before RT. Meanwhile, the total dose (cutoff value 60 Gy) of planning gross tumor volume (PGTV) and chemotherapy was also identified as independent prognostic indicator for LRFFS and DMFS, respectively. 72 patients had treatment failure and 58 (80.6%), 6 (8.3%), and 18 (25.0%) patients had experienced local, regional, and distant failure, respectively. Few severe toxicities were observed. The conservative definitive RT with modern technique was effective for very elderly EC patients in short term with low rate and tolerable toxicities. Local residue or recurrence was the most common failure pattern. The aging‐related prognostic factors concerned nutrition and immune, such as NRI and NLR before RT, should be considered for use in future clinical practice.
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spelling doaj.art-60c4b387a6294e7cb3bb9770183f089f2023-03-10T15:42:21ZengWileyCancer Medicine2045-76342018-05-01751837184410.1002/cam4.1456Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancerYong‐Chun Zhou0Li‐Li Chen1Hong‐Bo Xu2Qian Sun3Qi Zhang4Han‐Fei Cai5Hao Jiang6Department of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaDepartment of Radiation Oncology The First Affiliated Hospital of Bengbu Medical College No. 287, Chang Huai Road Bengbu 233000 ChinaAbstract Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive radiotherapy (RT) for very elderly EC patients. We retrospectively analyzed 149 very elderly EC patients consecutively treated between January 2015 and June 2016 by definitive intensity‐modulated radiotherapy (IMRT) with or without chemotherapy. The clinical outcome and toxicities were assessed, and the potential prognostic factors, such as nutritional risk index (NRI) and neutrophil–lymphocyte ratio (NLR), were analyzed statistically. The median follow‐up time for survivors was 22.5 months. The 2‐year overall survival (OS), local–regional failure‐free survival (LRFFS), and distant metastasis‐free survival (DMFS) were 51.6%, 54.7%, and 85.2%, respectively. Independent predictors for poorer OS were higher American Joint Committee on Cancer (AJCC) stage, lower NRI, and higher NLR value before RT. Meanwhile, the total dose (cutoff value 60 Gy) of planning gross tumor volume (PGTV) and chemotherapy was also identified as independent prognostic indicator for LRFFS and DMFS, respectively. 72 patients had treatment failure and 58 (80.6%), 6 (8.3%), and 18 (25.0%) patients had experienced local, regional, and distant failure, respectively. Few severe toxicities were observed. The conservative definitive RT with modern technique was effective for very elderly EC patients in short term with low rate and tolerable toxicities. Local residue or recurrence was the most common failure pattern. The aging‐related prognostic factors concerned nutrition and immune, such as NRI and NLR before RT, should be considered for use in future clinical practice.https://doi.org/10.1002/cam4.1456Concurrent chemoradiationdefinitive radiotherapyneutrophil–lymphocyte rationutritional risk indexvery elderly esophageal cancer
spellingShingle Yong‐Chun Zhou
Li‐Li Chen
Hong‐Bo Xu
Qian Sun
Qi Zhang
Han‐Fei Cai
Hao Jiang
Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
Cancer Medicine
Concurrent chemoradiation
definitive radiotherapy
neutrophil–lymphocyte ratio
nutritional risk index
very elderly esophageal cancer
title Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
title_full Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
title_fullStr Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
title_full_unstemmed Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
title_short Aging‐related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
title_sort aging related prognosis analysis of definitive radiotherapy for very elderly esophageal cancer
topic Concurrent chemoradiation
definitive radiotherapy
neutrophil–lymphocyte ratio
nutritional risk index
very elderly esophageal cancer
url https://doi.org/10.1002/cam4.1456
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