Definitive Chemoradiation Therapy for Esophageal Cancer in the Elderly: Clinical Outcomes for Patients Exceeding 80 Years Old

Cai Xu, Mian Xi, Amy Moreno, Yutaka Shiraishi, Brian P. Hobbs, Meilin Huang, Ritsuko Komaki, Steven H. Lin

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose The optimal treatment approach for patients ≥80 years (“elderly”) with esophageal cancer is not well established. We assessed the clinical outcomes in elderly patients treated with definitive chemoradiation therapy (CCRT) at our institution. Methods and Materials 56 consecutive patients ≥80 years with esophageal cancer treated with conventional CCRT between 2001 and 2016 were propensity score matched 1:2 to generate 2 younger patient cohorts treated with CCRT without surgery: “intermediate” (65-79 years, n=112) and “younger” (<65 years, n=112). Treatment related toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0. The rates of overall survival (OS) and recurrence-free survival (RFS) were calculated with the Kaplan-Meier method. Results The median ages of the 3 cohorts were 81 years (elderly, 80-92 years), 71 years (intermediate, 65-79 years), and 58 years (younger, 20-64 years). The elderly cohort was more likely to have cardiac comorbidities. Although the clinical complete response (cCR) rate deviated significantly among the 3 cohorts, (78%, 72%, and 56%; P=.004), the data failed to identify statistically significant differences among RFS, 2-year, and 5-year OS, or in median survival, which was 15.5 months, 23.6 months, and 20.2 months (P=.468), respectively. The overall severe toxicity rates were 38%, 32%, and 30%, respectively (P=.644), including comparable rate of radiation pneumonitis (P>.05). The elderly cohort, however, did show statistically significant evidence of an increased rate of severe radiation pneumonitis (grade ≥3) which was observed to be 11% versus 4% and 0%, respectively (P=.003). Conclusions The studied elderly population showed evidence of similar long-term clinical efficacy after definitive CCRT when compared with cohorts of younger patients with similar prognostic status. An increased rate of pulmonary toxicity was identified, without evidence of differences for nonpulmonary severe adverse events. Understanding the prognostic risk factors of pulmonary toxicity after CCRT may effectuate improved long-term outcomes for elderly population.

Original languageEnglish
Pages (from-to)811-819
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume98
Issue number4
DOIs
Publication statusPublished - 2017 Jul 15
Externally publishedYes

Fingerprint

Esophageal Neoplasms
therapy
cancer
toxicity
Radiation Pneumonitis
Therapeutics
Lung
Propensity Score
surgery
Population
grade
radiation

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Definitive Chemoradiation Therapy for Esophageal Cancer in the Elderly : Clinical Outcomes for Patients Exceeding 80 Years Old. / Xu, Cai; Xi, Mian; Moreno, Amy; Shiraishi, Yutaka; Hobbs, Brian P.; Huang, Meilin; Komaki, Ritsuko; Lin, Steven H.

In: International Journal of Radiation Oncology Biology Physics, Vol. 98, No. 4, 15.07.2017, p. 811-819.

Research output: Contribution to journalArticle

Xu, Cai ; Xi, Mian ; Moreno, Amy ; Shiraishi, Yutaka ; Hobbs, Brian P. ; Huang, Meilin ; Komaki, Ritsuko ; Lin, Steven H. / Definitive Chemoradiation Therapy for Esophageal Cancer in the Elderly : Clinical Outcomes for Patients Exceeding 80 Years Old. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 98, No. 4. pp. 811-819.
@article{d4085b182d87422dab13627bf50f11ba,
title = "Definitive Chemoradiation Therapy for Esophageal Cancer in the Elderly: Clinical Outcomes for Patients Exceeding 80 Years Old",
abstract = "Purpose The optimal treatment approach for patients ≥80 years (“elderly”) with esophageal cancer is not well established. We assessed the clinical outcomes in elderly patients treated with definitive chemoradiation therapy (CCRT) at our institution. Methods and Materials 56 consecutive patients ≥80 years with esophageal cancer treated with conventional CCRT between 2001 and 2016 were propensity score matched 1:2 to generate 2 younger patient cohorts treated with CCRT without surgery: “intermediate” (65-79 years, n=112) and “younger” (<65 years, n=112). Treatment related toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0. The rates of overall survival (OS) and recurrence-free survival (RFS) were calculated with the Kaplan-Meier method. Results The median ages of the 3 cohorts were 81 years (elderly, 80-92 years), 71 years (intermediate, 65-79 years), and 58 years (younger, 20-64 years). The elderly cohort was more likely to have cardiac comorbidities. Although the clinical complete response (cCR) rate deviated significantly among the 3 cohorts, (78{\%}, 72{\%}, and 56{\%}; P=.004), the data failed to identify statistically significant differences among RFS, 2-year, and 5-year OS, or in median survival, which was 15.5 months, 23.6 months, and 20.2 months (P=.468), respectively. The overall severe toxicity rates were 38{\%}, 32{\%}, and 30{\%}, respectively (P=.644), including comparable rate of radiation pneumonitis (P>.05). The elderly cohort, however, did show statistically significant evidence of an increased rate of severe radiation pneumonitis (grade ≥3) which was observed to be 11{\%} versus 4{\%} and 0{\%}, respectively (P=.003). Conclusions The studied elderly population showed evidence of similar long-term clinical efficacy after definitive CCRT when compared with cohorts of younger patients with similar prognostic status. An increased rate of pulmonary toxicity was identified, without evidence of differences for nonpulmonary severe adverse events. Understanding the prognostic risk factors of pulmonary toxicity after CCRT may effectuate improved long-term outcomes for elderly population.",
author = "Cai Xu and Mian Xi and Amy Moreno and Yutaka Shiraishi and Hobbs, {Brian P.} and Meilin Huang and Ritsuko Komaki and Lin, {Steven H.}",
year = "2017",
month = "7",
day = "15",
doi = "10.1016/j.ijrobp.2017.02.097",
language = "English",
volume = "98",
pages = "811--819",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Definitive Chemoradiation Therapy for Esophageal Cancer in the Elderly

T2 - Clinical Outcomes for Patients Exceeding 80 Years Old

AU - Xu, Cai

AU - Xi, Mian

AU - Moreno, Amy

AU - Shiraishi, Yutaka

AU - Hobbs, Brian P.

AU - Huang, Meilin

AU - Komaki, Ritsuko

AU - Lin, Steven H.

PY - 2017/7/15

Y1 - 2017/7/15

N2 - Purpose The optimal treatment approach for patients ≥80 years (“elderly”) with esophageal cancer is not well established. We assessed the clinical outcomes in elderly patients treated with definitive chemoradiation therapy (CCRT) at our institution. Methods and Materials 56 consecutive patients ≥80 years with esophageal cancer treated with conventional CCRT between 2001 and 2016 were propensity score matched 1:2 to generate 2 younger patient cohorts treated with CCRT without surgery: “intermediate” (65-79 years, n=112) and “younger” (<65 years, n=112). Treatment related toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0. The rates of overall survival (OS) and recurrence-free survival (RFS) were calculated with the Kaplan-Meier method. Results The median ages of the 3 cohorts were 81 years (elderly, 80-92 years), 71 years (intermediate, 65-79 years), and 58 years (younger, 20-64 years). The elderly cohort was more likely to have cardiac comorbidities. Although the clinical complete response (cCR) rate deviated significantly among the 3 cohorts, (78%, 72%, and 56%; P=.004), the data failed to identify statistically significant differences among RFS, 2-year, and 5-year OS, or in median survival, which was 15.5 months, 23.6 months, and 20.2 months (P=.468), respectively. The overall severe toxicity rates were 38%, 32%, and 30%, respectively (P=.644), including comparable rate of radiation pneumonitis (P>.05). The elderly cohort, however, did show statistically significant evidence of an increased rate of severe radiation pneumonitis (grade ≥3) which was observed to be 11% versus 4% and 0%, respectively (P=.003). Conclusions The studied elderly population showed evidence of similar long-term clinical efficacy after definitive CCRT when compared with cohorts of younger patients with similar prognostic status. An increased rate of pulmonary toxicity was identified, without evidence of differences for nonpulmonary severe adverse events. Understanding the prognostic risk factors of pulmonary toxicity after CCRT may effectuate improved long-term outcomes for elderly population.

AB - Purpose The optimal treatment approach for patients ≥80 years (“elderly”) with esophageal cancer is not well established. We assessed the clinical outcomes in elderly patients treated with definitive chemoradiation therapy (CCRT) at our institution. Methods and Materials 56 consecutive patients ≥80 years with esophageal cancer treated with conventional CCRT between 2001 and 2016 were propensity score matched 1:2 to generate 2 younger patient cohorts treated with CCRT without surgery: “intermediate” (65-79 years, n=112) and “younger” (<65 years, n=112). Treatment related toxicity was assessed using the Common Terminology Criteria for Adverse Events version 4.0. The rates of overall survival (OS) and recurrence-free survival (RFS) were calculated with the Kaplan-Meier method. Results The median ages of the 3 cohorts were 81 years (elderly, 80-92 years), 71 years (intermediate, 65-79 years), and 58 years (younger, 20-64 years). The elderly cohort was more likely to have cardiac comorbidities. Although the clinical complete response (cCR) rate deviated significantly among the 3 cohorts, (78%, 72%, and 56%; P=.004), the data failed to identify statistically significant differences among RFS, 2-year, and 5-year OS, or in median survival, which was 15.5 months, 23.6 months, and 20.2 months (P=.468), respectively. The overall severe toxicity rates were 38%, 32%, and 30%, respectively (P=.644), including comparable rate of radiation pneumonitis (P>.05). The elderly cohort, however, did show statistically significant evidence of an increased rate of severe radiation pneumonitis (grade ≥3) which was observed to be 11% versus 4% and 0%, respectively (P=.003). Conclusions The studied elderly population showed evidence of similar long-term clinical efficacy after definitive CCRT when compared with cohorts of younger patients with similar prognostic status. An increased rate of pulmonary toxicity was identified, without evidence of differences for nonpulmonary severe adverse events. Understanding the prognostic risk factors of pulmonary toxicity after CCRT may effectuate improved long-term outcomes for elderly population.

UR - http://www.scopus.com/inward/record.url?scp=85020473438&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020473438&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2017.02.097

DO - 10.1016/j.ijrobp.2017.02.097

M3 - Article

C2 - 28602412

AN - SCOPUS:85020473438

VL - 98

SP - 811

EP - 819

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 4

ER -