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The Uptake and Efficacy of Neoadjuvant Therapy in Older Adults with Locally Advanced Esophogastric Cancer

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Abstract

Background

Data on Neo+/− adjuvant treatment in older patients with cancer is sparse. The management of locally advanced esophagogastric cancer (LAEC) in older patients was evaluated to determine treatment modalities and identify factors associated with survival.

Methods

Patients diagnosed with LAEC (stage II or III) over 5 years were identified from the National Cancer Registry of Ireland. Treatment was classified as “best supportive care (BSC),” “surgery only,” “neo/adjuvant treatment,” and “chemo/radiation alone.”Survival was assessed. Univariate and multivariate analysis (MVA) of clinicopathological factors and treatment was conducted.

Results

Forty-six percent (n = 580) of the 1251 patients were ≥ 70 years, 11% (n = 134) received BSC, 23% (n = 288) surgery only, 31% (n = 390) had chemo/radiation alone, and 35% (n = 439) had neo/adjuvant treatment. Forty-six percent, 10%, and 0% of patients < 75, ≥ 75, and ≥ 80 years of age, respectively, received neoadjuvant treatment. Age was associated with treatment received (p < 0.001). Older patients were less likely to receive neo/adjuvant treatment, surgery, and any treatment. Median survival (OS) decreased with age (< 70 years: 23 months; 70–74: 19 months; 75–79: 13 months; ≥ 80 years: 10 months). In MVA, older age, smoking, later stage, and higher grade were significantly associated with a higher risk of death. Patients receiving neo/adjuvant treatment had lower risk of death than any other treatment group regardless of age.

Conclusion

Older patients were less likely to receive treatment for LAEC than younger patients. Patients aged ≥ 70 years benefit from neo/adjuvant treatment. Prospective clinical trials focusing on older patients and incorporating life expectancy, comorbidities, and geriatric assessment are needed to guide treatment.

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Authors and Affiliations

  1. University Hospital Waterford, Waterford, Ireland

    Petra Martin & Anne Horgan

  2. Midland Regional Hospital Tullamore, Tullamore, Ireland

    Petra Martin

  3. St. James’s Hospital, Dublin, Ireland

    Petra Martin

  4. National Cancer Registry Ireland (NCRI), Cork, Ireland

    Eamonn O’Leary & Sandra Deady

Authors
  1. Petra Martin
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  2. Eamonn O’Leary
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  3. Sandra Deady
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Correspondence to Petra Martin.

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Martin, P., O’Leary, E., Deady, S. et al. The Uptake and Efficacy of Neoadjuvant Therapy in Older Adults with Locally Advanced Esophogastric Cancer. J Gastrointest Canc 51, 893–900 (2020). https://doi.org/10.1007/s12029-019-00320-y

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  • DOI: https://doi.org/10.1007/s12029-019-00320-y

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