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Advanced Age is Not a Contraindication for Treatment With Curative Intent in Esophageal Cancer

Voncken, Francine E.M., MD*; van der Kaaij, Rosa T., MD†; Sikorska, Karolina, PhD‡; van Werkhoven, Erik, MSc‡; van Dieren, Jolanda M., MD, PhD§; Grootscholten, Cecile, MD, PhD§; Snaebjornsson, Petur, MD, PhD∥; van Sandick, Johanna W., MD, PhD†; Aleman, Berthe M.P., MD, PhD*

American Journal of Clinical Oncology: September 2018 - Volume 41 - Issue 9 - p 919–926
doi: 10.1097/COC.0000000000000390
Original Articles: Thoracic

Objectives: The objective of this study is to compare long-term outcomes between younger and older (70 y and above) esophageal cancer patients treated with curative intent.

Materials and Methods: Overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free interval were compared between older (70 y and above) and younger (below 70 y) esophageal cancer patients treated between 1998 and 2013. Treatment consisted of neoadjuvant chemoradiotherapy with surgery or definitive chemoradiotherapy: 36 to 50.4 Gy in 18 to 28 fractions combined with 5-fluorouracil/cisplatin or carboplatin/paclitaxel.

Results: The study comprised 253 patients, of whom 76 were 70 years and older. Median age was 64 years (range, 41 to 83). Most patients had stage II-IIIA disease (83%). Planned treatment was neoadjuvant chemoradiotherapy with surgery for 169 patients (41 patients aged 70 y and older) and definitive chemoradiotherapy for 84 patients (31 patients aged 70 y and older). The compliance to radiotherapy was 92%, with no difference between older and younger patients. In 33 patients (13 patients aged 70 y and older) planned surgery was not performed. Median follow-up was 4.9 years. Three-year OS was 42%. The multivariable analysis showed no statistical difference in OS or in DFS comparing older and younger patients: OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.61-1.28), DFS (HR, 0.87; 95% CI, 0.60-1.25). Elderly showed a longer locoregional recurrence-free interval; HR, 0.53 (95% CI, 0.30-0.92; P=0.02) and a higher pathologic complete response rate (50% vs. 25%; P=0.02).

Conclusions: Long-term outcomes of older esophageal cancer patients (70 y and above) selected for treatment with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy were comparable with the outcomes of their younger counterparts. Advanced age alone should not be a contraindication for potentially curative chemoradiotherapy-based treatment in esophageal cancer patients.

Departments of *Radiation Oncology

†Surgical Oncology

‡Biometrics

§Gastrointestinal Oncology

∥Pathology of The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Amsterdam, The Netherlands

F.E.M.V. and R.T.V.K. contributed equally.

Supported by The Netherlands Cancer Institute.

The authors declare no conflicts of interest.

Reprints: Berthe M.P. Aleman, MD, PhD, The Netherlands Cancer Institute—Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. E-mail: b.aleman@nki.nl.

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