Department of Radiation Oncology, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
Strahlenther Onkol. 2012 Mar;188(3):226-32. doi: 10.1007/s00066-011-0039-2. Epub 2012 Feb 10.
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/m(2) on days 1-5 and days 29-33) and 5-fluorouracil (650-1,000 mg/m(2) 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.
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.
Prognosis in elderly patients with inoperable esophageal cancer undergoing definitive radiotherapy/radiochemotherapy is limited, although it is not inferior to patients < 70 years.
越来越多的肿瘤放射科医生需要面对患有合并症和体能状态下降的老年癌症患者。由于针对这一特定患者群体的数据较少，本研究旨在评估不能手术的 70 岁及以上食管癌患者接受根治性放疗或放化疗的预后。
回顾性纳入 1995 年至 2006 年在德国科隆大学接受根治性放（化）疗的年龄≥70 岁、不能手术的食管癌患者。放疗最大总剂量为 63Gy（5×1.8Gy/周）。化疗包括顺铂（第 1-5 天和第 29-33 天，20mg/m2）和氟尿嘧啶（第 1-5 天和第 29-33 天，650-1000mg/m2）。疗效与同一时期接受相同方案治疗的 152 名<70 岁患者的队列进行比较。
共确定 51 名年龄≥70 岁、不能手术的食管癌患者接受根治性治疗（I/II 期 23.5%，III 期 56.9%，IV 期 9.8%；鳞状细胞癌 74.5%，腺癌 25.5%）。15 名患者（29.4%）接受联合放化疗（RCT），40 名患者（70.6%）接受单纯放疗（RT）。无进展生存期（PFS）中位数为 9.5 个月；总生存期（OS）中位数为 13.9 个月。接受 RCT 治疗的患者 2 年 OS 率为 53.3%，而 RT 患者为 16.7%（p=0.039）。临床淋巴结阴性患者的 2 年 OS 率为 38.5%，而淋巴结阳性患者为 21.2%（p=0.072）。≥70 岁患者的中位 OS 与<70 岁患者的队列（n=152）无显著差异（13.9 与 7.2 个月，p=0.072），但 PFS 差异有统计学意义（4.9 与 9.5 个月，p=0.026），倾向于>70 岁组。
对于接受根治性放化疗的不能手术的老年食管癌患者，预后有限，尽管并不劣于<70 岁患者。
