Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China.
Radiat Oncol. 2021 Oct 30;16(1):207. doi: 10.1186/s13014-021-01931-1.
There is still no definitely therapeutic evidence of a beneficial effect of chemotherapy with radiotherapy for older patients with esophageal squamous cell carcinoma (ESCC). We aim to determine the influence of chemoradiotherapy (CRT) and radiotherapy (RT) alone in patients aged 65 years or older with locally advanced ESCC.
We retrospectively analyzed 581 ESCC patients who underwent CRT and RT alone. Univariate and multivariate Cox regression analysis was used to analyze the impact of clinical factors on long-term overall survival (OS) and progression-free survival (PFS). Finally, we compared the toxicity rates of these patients.
The median OS and PFS of the overall population were 23.2 months (2.0-162.6 months) and 18.6 months (1.1-159.6 months). Multivariate Cox regression analysis showed that chemotherapy (p < 0.05), tumor thickness (p < 0.01), and N stage (p < 0.05) were independent prognostic factors associated with both OS and PFS. In the chemotherapy subgroup, patients who received 2-8 cycles of chemotherapy had better OS than those who received 1 cycle (p = 0.015). The results also revealed that the CRT group has better OS and PFS than RT alone group for patients aged 65-74 years (both p < 0.01). However, for patients aged 75 years or older, there was no statistically significant difference between CRT and RT alone (both p > 0.05). Besides, higher staged ESCC has the inferior OS and PFS than lower staged ESCC for patients received RT alone and aged 65-74 years (both p < 0.05). Finally, there were significantly more severe hematologic toxicities in the CRT group than in those treated with RT alone in this study (p < 0.001).
The present study suggested that CRT for locally advanced ESCC in patients aged 65 years or older had a significant benefit over RT alone in terms of OS and PFS. However, for patients aged 75 years or older, there was no statistically significant difference between CRT and RT alone. CRT should be performed with special attention in patients aged 75 years or older.
对于年龄较大的食管鳞状细胞癌（ESCC）患者，化疗联合放疗的疗效尚无明确的治疗证据。我们旨在确定放化疗（CRT）和单纯放疗（RT）对 65 岁或以上局部晚期 ESCC 患者的影响。
我们回顾性分析了 581 例接受 CRT 和 RT 单独治疗的 ESCC 患者。采用单因素和多因素 Cox 回归分析，分析临床因素对总生存期（OS）和无进展生存期（PFS）的影响。最后，我们比较了这些患者的毒性发生率。
全人群的中位 OS 和 PFS 分别为 23.2 个月（2.0-162.6 个月）和 18.6 个月（1.1-159.6 个月）。多因素 Cox 回归分析表明，化疗（p<0.05）、肿瘤厚度（p<0.01）和 N 分期（p<0.05）是与 OS 和 PFS 相关的独立预后因素。在化疗亚组中，接受 2-8 个周期化疗的患者 OS 优于仅接受 1 个周期化疗的患者（p=0.015）。结果还表明，65-74 岁患者 CRT 组的 OS 和 PFS 优于 RT 组（均 p<0.01）。然而，对于 75 岁或以上的患者，CRT 与 RT 单独治疗之间无统计学差异（均 p>0.05）。此外，对于接受 RT 单独治疗的 65-74 岁患者，较高分期的 ESCC 比较低分期的 ESCC 具有更差的 OS 和 PFS（均 p<0.05）。最后，与 RT 单独治疗组相比，本研究中 CRT 组的严重血液学毒性显著更多（p<0.001）。
本研究表明，对于 65 岁或以上的局部晚期 ESCC 患者，与单纯 RT 相比，CRT 在 OS 和 PFS 方面具有显著优势。然而，对于 75 岁或以上的患者，CRT 与 RT 单独治疗之间无统计学差异。对于 75 岁或以上的患者，CRT 应特别注意。
