Mantziari Styliani, Teixeira Farinha Hugo, Bouygues Vianney, Vignal Jean-Charles, Deswysen Yannick, Demartines Nicolas, Schäfer Markus, Piessen Guillaume
Department of Visceral Surgery, Faculty of Biology and Medicine UNIL, Rue du Bugnon 46, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.
Department of Digestive Surgery, CH Saint Brieuc, 10 Rue Marcel Proust, 22000 Saint-Brieuc, France.
Cancers (Basel). 2021 Apr 27;13(9):2104. doi: 10.3390/cancers13092104.
Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70-79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.
食管癌尽管在年轻患者中有增加的趋势，但仍然是一种老年疾病，发病高峰在70 - 79岁之间。尽管如此，老年患者仍被排除在主要临床试验之外，即使对于可治愈阶段的疾病，他们也常常接受次优治疗。在本综述中，与姑息治疗或不治疗相比，接受新辅助治疗、手术甚至根治性放化疗的老年患者显示出明显的生存获益。与年轻患者相比，老年患者手术往往伴随着更高的发病率和死亡率，可能会使年老体弱的患者失去自主能力的风险增加。根治性放化疗是为老年患者提供的主要治疗方式，尤其是对于鳞状细胞癌，效果非常显著，尽管可能会出现较高的急性毒性发生率。基于以上所有情况，虽然现有最佳证据来自回顾性研究，但仅基于年龄而不对老年患者进行根治性治疗是不合理的。进行全面评估并制定适应性治疗方案，以及将老年患者纳入正在进行的临床试验，将有助于更好地了解和管理这一异质性且通常体弱的人群中的食管癌。
