Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
Background and purposeTo evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).Materials and methodsThis multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73...
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1063670/full |
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| author | Tilman Bostel Tilman Bostel Sati Akbaba Sati Akbaba Daniel Wollschläger Daniel Wollschläger Arnulf Mayer Arnulf Mayer Eirini Nikolaidou Eirini Nikolaidou Markus Murnik Markus Murnik Simon Kirste Simon Kirste Alexander Rühle Alexander Rühle Anca-Ligia Grosu Anca-Ligia Grosu Jürgen Debus Jürgen Debus Christian Fottner Christian Fottner Markus Moehler Markus Moehler Peter Grimminger Peter Grimminger Heinz Schmidberger Heinz Schmidberger Nils Henrik Nicolay Nils Henrik Nicolay Nils Henrik Nicolay |
| author_facet | Tilman Bostel Tilman Bostel Sati Akbaba Sati Akbaba Daniel Wollschläger Daniel Wollschläger Arnulf Mayer Arnulf Mayer Eirini Nikolaidou Eirini Nikolaidou Markus Murnik Markus Murnik Simon Kirste Simon Kirste Alexander Rühle Alexander Rühle Anca-Ligia Grosu Anca-Ligia Grosu Jürgen Debus Jürgen Debus Christian Fottner Christian Fottner Markus Moehler Markus Moehler Peter Grimminger Peter Grimminger Heinz Schmidberger Heinz Schmidberger Nils Henrik Nicolay Nils Henrik Nicolay Nils Henrik Nicolay |
| author_sort | Tilman Bostel |
| collection | DOAJ |
| description | Background and purposeTo evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).Materials and methodsThis multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed.ResultsThe delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001).ConclusionsChemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort. |
| first_indexed | 2024-04-10T05:56:22Z |
| format | Article |
| id | doaj.art-9c3743aacd3947bea987dc8598f478b5 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-10T05:56:22Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-9c3743aacd3947bea987dc8598f478b52023-03-03T13:32:16ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-03-011310.3389/fonc.2023.10636701063670Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderlyTilman Bostel0Tilman Bostel1Sati Akbaba2Sati Akbaba3Daniel Wollschläger4Daniel Wollschläger5Arnulf Mayer6Arnulf Mayer7Eirini Nikolaidou8Eirini Nikolaidou9Markus Murnik10Markus Murnik11Simon Kirste12Simon Kirste13Alexander Rühle14Alexander Rühle15Anca-Ligia Grosu16Anca-Ligia Grosu17Jürgen Debus18Jürgen Debus19Christian Fottner20Christian Fottner21Markus Moehler22Markus Moehler23Peter Grimminger24Peter Grimminger25Heinz Schmidberger26Heinz Schmidberger27Nils Henrik Nicolay28Nils Henrik Nicolay29Nils Henrik Nicolay30Department of Radiation Oncology, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyInstitute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, GermanyDepartment of Radiation Oncology, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University Hospital of Heidelberg, Heidelberg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Heidelberg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Internal Medicine I, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Internal Medicine I, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of General, Visceral and Transplant Surgery, University Medical Center Mainz, Mainz, GermanyDepartment of Radiation Oncology, University Medical Center Mainz, Mainz, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Mainz, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, University of Freiburg – Medical Center, Freiburg, GermanyGerman Cancer Consortium (Deutsches Konsortium fur Translationale Krebsforschung - DKTK) Partner Site Freiburg, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Heidelberg, Germany0Department of Radiation Oncology, University of Leipzig Medical Center, Leipzig, GermanyBackground and purposeTo evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).Materials and methodsThis multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed.ResultsThe delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001).ConclusionsChemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort.https://www.frontiersin.org/articles/10.3389/fonc.2023.1063670/fullesophageal cancerelderly patientssquamous cell cancerchemoradiationradiotherapy |
| spellingShingle | Tilman Bostel Tilman Bostel Sati Akbaba Sati Akbaba Daniel Wollschläger Daniel Wollschläger Arnulf Mayer Arnulf Mayer Eirini Nikolaidou Eirini Nikolaidou Markus Murnik Markus Murnik Simon Kirste Simon Kirste Alexander Rühle Alexander Rühle Anca-Ligia Grosu Anca-Ligia Grosu Jürgen Debus Jürgen Debus Christian Fottner Christian Fottner Markus Moehler Markus Moehler Peter Grimminger Peter Grimminger Heinz Schmidberger Heinz Schmidberger Nils Henrik Nicolay Nils Henrik Nicolay Nils Henrik Nicolay Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly Frontiers in Oncology esophageal cancer elderly patients squamous cell cancer chemoradiation radiotherapy |
| title | Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly |
| title_full | Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly |
| title_fullStr | Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly |
| title_full_unstemmed | Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly |
| title_short | Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly |
| title_sort | chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus multi center analysis on the value of standard treatment in the elderly |
| topic | esophageal cancer elderly patients squamous cell cancer chemoradiation radiotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1063670/full |
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