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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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