Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
PhD Program in Translational Medicine, National Chung-Hsing University, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2020 Oct;83(10):906-910. doi: 10.1097/JCMA.0000000000000419.
Neoadjuvant chemoradiotherapy (CRT) followed by an esophagectomy is the standard treatment for locally advanced esophageal cancer, but remains a great challenge for elderly patients. Therefore, we aim to evaluate the efficacy of definitive CRT in elderly patients with esophageal cancer.
From December 2007 to October 2017, 40 esophageal cancer patients aged ≥70 years receiving definitive CRT were retrospectively analyzed. All patients received cisplatin-based chemotherapy. Ten patients received standard doses of cisplatin 20 mg/m and fluorouracil (5-FU) 800 mg/m for 4 days, during the first and fifth weeks of radiotherapy. Eighteen patients received modified doses of cisplatin 16 to 18 mg/m and 5-FU 600 to 800 mg/m. Twelve patients received lower doses of cisplatin 10 to 12 mg/m and 5-FU 400 to 600 mg/m. The endpoints were overall survival (OS), tumor response rate, and treatment compliance.
The 3-year OS rate was 28.8% The 3-year OS rates for patients receiving standard, modified, and lower doses were 12.5%, 53.8%, and 0.0%, respectively (p = 0.05). There were 87.5% of patients completing the scheduled radiotherapy dose, along with two cycles of concurrent chemotherapy. The response rate (clinical complete response and partial response rate) was 70.0%. Multivariate analysis revealed that no statistical difference was found in the OS among three groups of chemotherapy dosage. The treatment response was the only independent prognostic factor to OS (p < 0.001).
Definitive CRT with dose modification is a feasible, safe, and reasonable treatment for elderly esophageal cancer patients. Achieving a better compliance to CRT via an optimal dose modification of chemotherapy may provide better clinical outcomes and would be the treatment goal for elderly esophageal cancer patients.
新辅助放化疗（CRT）后行食管切除术是局部晚期食管癌的标准治疗方法，但对老年患者仍是一大挑战。因此，我们旨在评估根治性 CRT 对老年食管癌患者的疗效。
回顾性分析 2007 年 12 月至 2017 年 10 月间 40 例接受根治性 CRT 的≥70 岁食管癌患者。所有患者均接受基于顺铂的化疗。10 例患者接受标准剂量顺铂 20mg/m2和氟尿嘧啶（5-FU）800mg/m2，在放疗的第 1 周和第 5 周各用 4 天。18 例患者接受改良剂量顺铂 16-18mg/m2和 5-FU 600-800mg/m2。12 例患者接受低剂量顺铂 10-12mg/m2和 5-FU 400-600mg/m2。主要终点为总生存期（OS）、肿瘤反应率和治疗依从性。
3 年 OS 率为 28.8%。接受标准、改良和低剂量治疗的患者 3 年 OS 率分别为 12.5%、53.8%和 0.0%（p=0.05）。87.5%的患者完成了计划的放疗剂量和两个周期的同期化疗。反应率（临床完全缓解和部分缓解率）为 70.0%。多因素分析显示，三组化疗剂量的 OS 无统计学差异。治疗反应是 OS 的唯一独立预后因素（p<0.001）。
对老年食管癌患者进行剂量调整的根治性 CRT 是一种可行、安全且合理的治疗方法。通过优化化疗剂量调整来提高 CRT 的依从性，可能会提供更好的临床结果，这将是老年食管癌患者的治疗目标。
