Japan Esophageal Society, Tokyo, Japan.
Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
Esophagus. 2020 Jul;17(3):223-229. doi: 10.1007/s10388-020-00725-w. Epub 2020 Feb 22.
There has been no definitive evidence of chemoradiotherapy being superior to radiotherapy alone in patients aged 80 years or older. The purpose of the present study was to evaluate the results of radiotherapy and chemoradiotherapy in patients aged 80 years or older with esophageal cancer in the Japanese Nationwide Cancer Database.
A total of 358 patients aged 80 years or older who were treated with radiotherapy alone or with chemoradiotherapy for esophageal cancer between 2009 and 2011 were enrolled.
The 5-year overall survival (OS) rates in patients with cStages 0-I, II, III and IV were 40.9%, 24.7%, 12.2% and 4.9%, respectively. The 5-year cause-specific survival (CSS) rates in patients aged 80 years or older with cStages 0-I, cStage II, cStage III and cStage IV were 73.5%, 41.4%, 25.3% and 7.4%, respectively. In patients treated with radiotherapy alone, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 36.5%, 12.0%, 5.4% and 0%, respectively. In patients treated with chemoradiotherapy, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 45.0%, 36.1%, 16.4% and 7.1%, respectively. In multivariate analysis, chemoradiotherapy, early stage and squamous cell carcinoma were significantly favorable prognostic factors for OS in patients aged 80 years or older (p < 0.001, p < 0.001 and p = 0.0323, respectively). We were unable to evaluate toxicities, because of lack of information in the registry.
Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80 years or older is a significantly favorable prognostic factor for OS. However, chemoradiotherapy should be carefully selected in elderly patients.
目前尚无明确证据表明 80 岁及以上患者的放化疗优于单纯放疗。本研究的目的是评估日本全国癌症数据库中 80 岁及以上食管癌患者单纯放疗与放化疗的结果。
共纳入 2009 年至 2011 年间接受单纯放疗或放化疗治疗的 358 例 80 岁及以上食管癌患者。
cStage 0-I、II、III 和 IV 期患者的 5 年总生存率（OS）分别为 40.9%、24.7%、12.2%和 4.9%。80 岁及以上 cStage 0-I、cStage II、cStage III 和 cStage IV 患者的 5 年疾病特异性生存率（CSS）分别为 73.5%、41.4%、25.3%和 7.4%。单纯放疗患者的 cStage 0-I、II、III 和 IV 期患者的 5 年 OS 率分别为 36.5%、12.0%、5.4%和 0%。接受放化疗的患者 cStage 0-I、II、III 和 IV 期患者的 5 年 OS 率分别为 45.0%、36.1%、16.4%和 7.1%。多因素分析显示，放化疗、早期和鳞状细胞癌是 80 岁及以上患者 OS 的显著预后因素（p<0.001、p<0.001 和 p=0.0323）。由于登记处缺乏信息，我们无法评估毒性。
80 岁及以上食管癌患者同步放化疗是 OS 的显著预后因素。然而，放化疗在老年患者中应谨慎选择。
