Voncken Francine E M, van der Kaaij Rosa T, Sikorska Karolina, van Werkhoven Erik, van Dieren Jolanda M, Grootscholten Cecile, Snaebjornsson Petur, van Sandick Johanna W, Aleman Berthe M P
Departments of Radiation Oncology.
Surgical Oncology.
Am J Clin Oncol. 2018 Sep;41(9):919-926. doi: 10.1097/COC.0000000000000390.
The objective of this study is to compare long-term outcomes between younger and older (70 y and above) esophageal cancer patients treated with curative intent.
Overall survival (OS), disease-free survival (DFS), and locoregional recurrence-free interval were compared between older (70 y and above) and younger (below 70 y) esophageal cancer patients treated between 1998 and 2013. Treatment consisted of neoadjuvant chemoradiotherapy with surgery or definitive chemoradiotherapy: 36 to 50.4 Gy in 18 to 28 fractions combined with 5-fluorouracil/cisplatin or carboplatin/paclitaxel.
The study comprised 253 patients, of whom 76 were 70 years and older. Median age was 64 years (range, 41 to 83). Most patients had stage II-IIIA disease (83%). Planned treatment was neoadjuvant chemoradiotherapy with surgery for 169 patients (41 patients aged 70 y and older) and definitive chemoradiotherapy for 84 patients (31 patients aged 70 y and older). The compliance to radiotherapy was 92%, with no difference between older and younger patients. In 33 patients (13 patients aged 70 y and older) planned surgery was not performed. Median follow-up was 4.9 years. Three-year OS was 42%. The multivariable analysis showed no statistical difference in OS or in DFS comparing older and younger patients: OS (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.61-1.28), DFS (HR, 0.87; 95% CI, 0.60-1.25). Elderly showed a longer locoregional recurrence-free interval; HR, 0.53 (95% CI, 0.30-0.92; P=0.02) and a higher pathologic complete response rate (50% vs. 25%; P=0.02).
Long-term outcomes of older esophageal cancer patients (70 y and above) selected for treatment with neoadjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy were comparable with the outcomes of their younger counterparts. Advanced age alone should not be a contraindication for potentially curative chemoradiotherapy-based treatment in esophageal cancer patients.
本研究的目的是比较接受根治性治疗的年轻和老年（70岁及以上）食管癌患者的长期预后。
比较1998年至2013年间接受治疗的老年（70岁及以上）和年轻（70岁以下）食管癌患者的总生存期（OS）、无病生存期（DFS）和局部区域无复发生存期。治疗包括新辅助放化疗联合手术或根治性放化疗：18至28次分割给予36至50.4Gy，联合5-氟尿嘧啶/顺铂或卡铂/紫杉醇。
该研究纳入253例患者，其中76例年龄在70岁及以上。中位年龄为64岁（范围41至83岁）。大多数患者为II-IIIA期疾病（83%）。计划治疗为169例患者（41例年龄在70岁及以上）行新辅助放化疗联合手术，84例患者（31例年龄在70岁及以上）行根治性放化疗。放疗依从性为92%，老年和年轻患者之间无差异。33例患者（13例年龄在70岁及以上）未按计划进行手术。中位随访时间为4.9年。三年总生存率为42%。多变量分析显示，比较老年和年轻患者，总生存期或无病生存期无统计学差异：总生存期（风险比[HR]，0.88；95%置信区间[CI]，0.61-1.28），无病生存期（HR，0.87；95%CI，0.60-1.25）。老年患者局部区域无复发生存期更长；HR，0.53（95%CI，0.30-0.92；P=0.02），病理完全缓解率更高（50%对25%；P=0.02）。
选择接受新辅助放化疗后手术或根治性放化疗的老年（70岁及以上）食管癌患者的长期预后与其年轻 counterparts 相当。单纯高龄不应成为食管癌患者潜在根治性放化疗治疗的禁忌证。
