Dataset Information

Treatment-related toxicity and outcomes in older versus younger patients with esophageal cancer treated with neoadjuvant chemoradiation.

ABSTRACT:

Background

Neoadjuvant chemoradiation (nCRT) followed by esophagectomy is the standard treatment for locally advanced esophageal cancer. Older patients are often felt to be poor candidates for nCRT. Limited data is available to guide the use of nCRT in this population.

Methods

A retrospective review of patients treated at a tertiary cancer center between 2002 and 2014 was conducted grouping patients by age (? 65 or?Results125 patients were identified for this study (67 aging <65, and 58???65). In the UVA, advanced age was only associated with increased hematologic toxicity (p?=?.04). After adjusting for covariates in the MVA, there were no significant differences in toxicity between older and younger patients. There were also no differences between overall survival and relapse free survival between age groups. Increased pre-treatment NLR was strongly correlated with advanced age (p?=?.01), increased hospitalizations (p?=?.04), and decreased RFS (p?=?.002).

Conclusions

Older patients who underwent nCRT followed by esophagectomy had similar toxicities and outcomes as younger patients suggesting that nCRT before esophagectomy is safe in select older adults with esophageal cancer. PLR and NLR may serve as prognostic markers of aging, toxicity, and outcomes. Further research is warranted to optimize the therapy of older patients with this disease.

SUBMITTER: Jain R

PROVIDER: S-EPMC7751616 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Publications

Treatment-related toxicity and outcomes in older versus younger patients with esophageal cancer treated with neoadjuvant chemoradiation.

Jain Rishi R Yee Jia-Llon JL Shaikh Talha T Au Cherry C Handorf Elizabeth E Meyer Joshua E JE Dotan Efrat E

Journal of geriatric oncology 20190628 4

<h4>Background</h4>Neoadjuvant chemoradiation (nCRT) followed by esophagectomy is the standard treatment for locally advanced esophageal cancer. Older patients are often felt to be poor candidates for nCRT. Limited data is available to guide the use of nCRT in this population.<h4>Methods</h4>A retrospective review of patients treated at a tertiary cancer center between 2002 and 2014 was conducted grouping patients by age (≥ 65 or < 65) for evaluation of differences in toxicity and outcomes. Eval ...[more]

PMID: 31257165

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Project description:BackgroundPatterns of overall and disease-free survival after esophagectomy for esophageal cancer in older adults have not been carefully studied.MethodsRetrospective analysis of all patients with esophageal cancer undergoing esophagectomy from 2005 to 2020 at our institution was performed. Differences in outcomes were stratified by age groups, < 75 and ≥ 75 years old, and two time periods, 2005-2012 and 2013-2020.ResultsA total of 1135 patients were included: 979 (86.3%) patients were < 75 (86.3%), and 156 (13.7%) were ≥ 75 years old. Younger patients had fewer comorbidities, better nutritional status, and were more likely to receive neoadjuvant and adjuvant therapy (all p < 0.05). However, tumor stage and operative approach were similar, except for increased performance of the McKeown technique in younger patients (p = 0.02). Perioperatively, younger patients experienced fewer overall and grade II complications (both p < 0.05). They had better overall survival (log-rank p-value < 0.001) and median survival, 62.2 vs. 21.5 months (p < 0.05). When stratified by pathologic stage, survival was similar for yp0 and pathologic stage II disease (both log-rank p-value > 0.05). Multivariable Cox models showed older age (≥ 75 years old) had increased hazard for reduced overall survival (HR 2.04 95% CI 1.5-2.8; p < 0.001) but not disease-free survival (HR 1.1 95% CI 0.78-1.6; p = 0.54). Over time, baseline characteristics remained largely similar, while stage became more advanced with a rise in neoadjuvant use and increased performance of minimally invasive esophagectomy (all p < 0.05). While overall complication rates improved (p < 0.05), overall and recurrence-free survival did not. Overall survival was better in younger patients during both time periods (both log-rank p < 0.05).ConclusionsDespite similar disease-free survival rates, long-term survival was decreased in older adults as compared to younger patients. This may be related to unmeasured factors including frailty, long-term complications after surgery, and competing causes of death. However, our results suggest that survival is similar in those with complete pathologic responses.

Dataset Information

Treatment-related toxicity and outcomes in older versus younger patients with esophageal cancer treated with neoadjuvant chemoradiation.

Background

Methods

Conclusions

Publications

Treatment-related toxicity and outcomes in older versus younger patients with esophageal cancer treated with neoadjuvant chemoradiation.

Similar Datasets

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