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Radiotherapy in elderly patients with inoperable esophageal cancer

Is there a benefit?

Strahlentherapie bei älteren Menschen mit inoperablem Ösophaguskarziom

Gibt es einen Vorteil?

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Abstract

Background

Radiation oncologists increasingly face elderly cancer patients impaired by comorbidities and reduced performance status. As less data are available for this particular group of patients, the aim of the study was to assess the prognosis of inoperable esophageal cancer patients ≥ 70 years undergoing definitive radiotherapy or radiochemotherapy.

Patients and treatment protocol

Patients aged ≥ 70 with inoperable carcinoma of the esophagus undergoing definitive radio(chemo)therapy between 1995 and 2006 at the University of Cologne were included retrospectively. Maximal total dose of radiotherapy administered was 63 Gy (5 × 1.8 Gy/week). Chemotherapy consisted of cisplatin (20 mg/m2 on days 1–5 and days 29–33) and 5-fluorouracil (650–1,000 mg/m2 on days 1–5 and days 29–33). Efficacy was compared with a cohort of 152 patients < 70 years treated with the same protocol during the same time period.

Results

A total of 51 patients aged  ≥ 70 with inoperable cancer of the esophagus undergoing definitive therapy were identified (stage I/II 23.5%, stage III 56.9%, stage IV 9.8%; squamous cell carcinoma 74.5%, adenocarcinoma 25.5%). While 15 patients (29.4%) received combined radiochemotherapy (RCT), 40 patients (70.6%) were treated with radiotherapy alone (RT). Median progression-free survival (PFS) was 9.5 months; median overall survival (OS) was 13.9 months. Patients treated with RCT had a 2-year OS rate of 53.3% compared with 16.7% for RT patients (p = 0.039). The 2-year OS for clinically lymph node negative patients was 38.5% compared with 21.2% for lymph node positive patients (p = 0.072). Median OS was not significantly different between patients ≥ 70 years versus the patient cohort (n = 152) aged < 70 years (13.9 vs. 7.2 months, p = 0.072) but PFS showed a significant difference (4.9 vs. 9.5 months, p = 0.026) in favor of the > 70 years group.

Conclusion

Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients < 70 years.

Zusammenfassung

Hintergrund

Das Tätigkeitsfeld des Radioonkologen wird zunehmend von älteren Patienten mit zahlreichen Komorbiditäten und reduziertem Allgemeinzustand bestimmt. Das Ziel der vorliegenden Studie war es, die Prognose inoperabler Ösophaguskarzinom-Patienten  ≥ 70 Jahre nach definitiver Strahlen-/Strahlenchemotherapie zu untersuchen, da die Datenlage bei dieser Patientengruppe unzureichend ist.

Patienten und Behandlungsprotokoll

Patienten  im Alter von ≥ 70 Jahren mit Ösophaguskarzinom, welche sich zwischen 1995 und 2006 an der Universität zu Köln einer definitiven Strahlentherapie/Strahlenchemotherapie unterzogen, wurden retrospektiv in die Studie eingeschlossen. Die Strahlentherapiedosis lag bei maximal 63 Gy (5 × 1,8 Gy/Woche), die simultane Chemotherapie bestand aus Cisplatin (20 mg/m2 an den Tagen 1–5 und 29–33) und 5-FU (650–1000 mg/m2 an den Tagen 1–5 und 29–33). Zum Vergleich der Effektivität wurde eine Kohorte aus 152 Patienten  < 70 Jahre, die im gleichen Zeitraum nach identischem Protokoll behandelt wurden, herangezogen.

Ergebnisse

Insgesamt wurden 51 Patienten  ≥ 70 Jahre mit inoperablem Ösophaguskarzinom identifiziert (davon 23,5% im Stadium I/II, 56,9% im Stadium III und 9,8% im Stadium IV; insgesamt 74,5% Plattenepithelkarzinome und 25,5% Adenokarzinome). Eine alleinige Radiotherapie (RT) erhielten 40 Patienten (70,6%), 15 Patienten (29,4%) wurden mit einer kombinierten Strahlenchemotherapie (RCT) behandelt. Das mediane progressionsfreie Überleben (PFS) lag bei 9,5 Monaten, das mediane Gesamtüberleben (OS) bei 13,9 Monaten. Die 2-Jahres-Gesamtüberlebensrate nach RCT betrug 53,3% im Vergleich zu 16,7% nach RT (p = 0,039). Die 2-Jahres-Gesamtüberlebensrate für cN0-Patienten erreichte 38,5% im Vergleich zu 21,2% für cN + -Patienten (p = 0,072). Das mediane OS der Patienten  ≥ 70 Jahre unterscheid sich nicht signifikant von der Patientenkohorte  < 70 Jahre (13,9 vs. 7,2 Monate; p = 0,072), jedoch zeigte das mediane PFS eine signifikante Differenz zugunsten der Patientengruppe  ≥ 70 Jahre (4,9 vs. 9,5 Monate; p = 0,026).

Zusammenfassung

Die Prognose älterer Patienten  ≥ 70 Jahre mit inoperablem Ösophaguskarzinom und nach definitiver Strahlen/Strahlenchemotherapie ist eingeschränkt, jedoch nicht signifikant schlechter als diejenige von Patienten  < 70 Jahre.

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Conflict of interest

The corresponding author states the following: lecturing and consulting activities, reimbursement of travel expenses by Merck-Pharma, Roche, and Zeiss Surgical.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    R. Semrau MD, S.L. Herzog, M. Kocher & R.-P. Müller

  2. Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany

    D. Vallböhmer & A. Hölscher

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  1. R. Semrau MD
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  2. S.L. Herzog
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  3. D. Vallböhmer
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  4. M. Kocher
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  5. A. Hölscher
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  6. R.-P. Müller
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Correspondence to R. Semrau MD.

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Semrau, R., Herzog, S., Vallböhmer, D. et al. Radiotherapy in elderly patients with inoperable esophageal cancer. Strahlenther Onkol 188, 226–234 (2012). https://doi.org/10.1007/s00066-011-0039-2

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  • DOI: https://doi.org/10.1007/s00066-011-0039-2

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