Phase II Study of a Platinum-Based Adapted Chemotherapy Regimen Combined with Radiotherapy in Patients 75 Years and Older with Esophageal Cancer
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Background and objective
The management of elderly patients with cancer is a therapeutic challenge and a public health problem. The aim of this phase II single-arm study was to evaluate the acute toxicities and efficacy of chemoradiotherapy (CRT) comprising a single platinum-based agent combined with radiotherapy in elderly patients with esophageal cancer.
Between March 2000 and October 2011, patients aged 75 years and older were prospectively treated with external beam radiotherapy combined with cisplatin or oxaliplatin. Other selection criteria included Eastern Cooperative Oncology Group status 0–2, disease stage II–III, squamous cell carcinoma or adenocarcinoma, and an adequate biological profile. The radiotherapy dose was 50 Gy administered over 5 weeks to the primary tumor and involved lymph nodes. Cisplatin was planned at a dose of 75 mg/m2 on days 1 and 21 and oxaliplatin at 85 mg/m2 on days 1, 15, and 29. Treatment was delivered an outpatient setting.
Thirty patients with a mean age of 85.2 (range 79.4–92.0) years were included; 28 completed the treatment. Dysphagia was the only grade 4 toxicity to occur during the study; no grade 5 toxicities were observed. Six weeks after the completion of treatment, 16 patients (53.3 %) were in complete response. Two patients in complete response died from pneumonitis 5 and 7 months after CRT. With a 36-month median follow-up, 18 patients died from cancer (nine from local failure, nine from metastasis). Seven patients died from other causes and two patients were alive 40.3 and 56 months after the end of their treatment. Three-year overall survival was 22.2 %.
Selected elderly patients with esophageal cancer and adequate functional status should not be excluded from CRT and may be able to tolerate the treatment with acceptable acute toxicities. However, mid-term efficacy is mediocre. Our data also suggest that the therapeutic ratio or locoregional control might be improved by increasing the radiotherapy dose or by testing new radiosensitizer agents since half of the failures were within the treated volume.
Trial Registration: EudraCT no. 2009-010113-76.
This study was funded in part by La Ligue Contre le Cancer. We would like to thank Philip Bastable for help with translation and proof-reading.
Conflict of interest
SSV, GC, BR, VG, PM, MP and JFB declare that they have no competing interests.
SSV and GC drafted the manuscript. SSV, GC, JFB, PM, BR and VG contributed to the design of the study and included patients in their center. MP performed the statistical analysis. All authors read and approved the final manuscript.
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