Safety and efficacy of radiation and chemoradiation in patients over 70 years old with inoperable esophageal squamous cell carcinoma

Xu,Hong‑Yu; Du,Ze‑Dong; Zhou,Lin; Yu,Min; Ding,Zhen‑Yu; Lu,You

doi:10.3892/ol.2013.1694

Safety and efficacy of radiation and chemoradiation in patients over 70 years old with inoperable esophageal squamous cell carcinoma

Authors:
- Hong‑Yu Xu
- Ze‑Dong Du
- Lin Zhou
- Min Yu
- Zhen‑Yu Ding
- You Lu
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Affiliations: Department of Thoracic Oncology and State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan 610041, P.R. China
Published online on: November 20, 2013 https://doi.org/10.3892/ol.2013.1694
Pages: 260-266

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Abstract

The aim of the present study was to perform a retrospective analysis to investigate the outcome and toxicity of radiation (RT) and chemoradiation (CRT) in elderly, inoperable patients >70 years old. Between 2003 and 2012, 1,024 patients with squamous cell carcinoma (SCC) of the esophagus were treated at the Department of Thoracic Cancer, West China Hospital (Chengdu, China). Of these patients, 37 were >70 years old and had not undergone surgery, and were selected for analysis. Of these 37 patients, CRT had been administered to 20 (54%). Actuarial survival rates were determined by the Kaplan‑Meier method. The one‑year survival rate in the CRT group (n=20) was 85%, while 35% of patients in the RT group (n=17) survived for more than one year. The overall and progression‑free survival in the CRT group versus the RT group were 17 months [95% confidence interval (CI), 11.861‑22.139] versus eight months (95% CI, 6.674‑9.326) (P=0.013) and 14 months (95% CI, 9.617‑18.383) versus five months (95% CI, 2.311‑7.689) (P=0.01), respectively. Patients irradiated with a dose of >50 Gy exhibited an improved survival rate compared with patients who received a dose of ≤50 Gy (18 vs. 14 months; P=0.049). Furthermore, patients with an Eastern Cooperative Oncology Group (ECOG) score of ≤1 had an improved prognosis compared with those with an ECOG score of 2 (14 vs. seven months; P=0.006). The two regimens were well‑tolerated and there were no therapy‑associated mortalities. The current retrospective study indicated that patients of >70 years old with inoperable esophageal SCC and a good ECOG score exhibit comparably better safety levels with CRT and improved survival rates compared with RT alone.

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1	National Cancer Institute. Cancer Statistics: SEER stat fact sheets: esophagus. http://seer.cancer.gov/statfacts/html/esoph.html. Accessed January 20, 2013
2	Zhang SW, Lei ZL, Li GL, Zou XL, Zhao P and Chen WQ: A report of cancer incidence and mortality from 34 cancer registries in China, 2006. China Cancer. 19:356–365. 2010.
3	Gholipour C, Shalchi RA and Abbasi M: A histopathological study of esophageal cancer on the western side of the Caspian littoral from 1994 to 2003. Dis Esophagus. 21:322–327. 2008. View Article : Google Scholar
4	Tran GD, Sun XD, Abnet CC, et al: Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China. Int J Cancer. 113:456–463. 2005. View Article : Google Scholar : PubMed/NCBI
5	Sun XD, Yu JM, Fan XL, Ren RM, Li MH and Zhang GL: Randomized clinical study of surgery versus radiotherapy alone in the treatment of resectable esophageal cancer in the chest. Zhonghua Zhong Liu Za Zhi. 28:784–787. 2006.(In Chinese).
6	Abrams JA, Buono DL, Strauss J, McBride RB, Hershman DL and Neugut AI: Esophagectomy compared with chemoradiation for early stage esophageal cancer in the elderly. Cancer. 115:4924–4933. 2009. View Article : Google Scholar
7	Smith TJ, Ryan LM, Douglass HO Jr, et al: Combined chemoradiotherapy vs. radiotherapy alone for early stage squamous cell carcinoma of the esophagus: a study of the Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys. 42:269–276. 1998. View Article : Google Scholar
8	Wobbes T, Baron B, Paillot B, et al: Prospective randomised study of split-course radiotherapy versus cisplatin plus split-course radiotherapy in inoperable squamous cell carcinoma of the oesophagus. Eur J Cancer. 37:470–477. 2001. View Article : Google Scholar
9	National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology™ version 2. 2012, http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed January 2, 2013
10	Freeman RK, Ascioti AJ and Mahidhara RJ: Palliative therapy for patients with unresectable esophageal carcinoma. Surg Clin North Am. 92:1337–1351. 2012. View Article : Google Scholar : PubMed/NCBI
11	Ikeda E, Kojima T, Kaneko K, et al: Efficacy of concurrent chemoradiotherapy as a palliative treatment in stage IVB esophageal cancer patients with dysphasia. Jpn J Clin Oncol. 41:964–972. 2011. View Article : Google Scholar
12	Law S, Wong KH, Kwok KF, Chu KM and Wong J: Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 240:791–800. 2004. View Article : Google Scholar
13	Nishino M, Jackman DM, Hatabu H, et al: New Response Evaluation Criteria in Solid Tumours (RECIST) guidelines for advanced non-small cell lung cancer: comparison with original RECIST and impact on assessment of tumor response to targeted therapy. AJR Am J Roentgenol. 195:W221–W228. 2010. View Article : Google Scholar
14	National Cancer Institute. Cancer Therapy Evaluation Program: protocol development. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/#ctc_30.htm. Accessed January 13, 2013
15	Mak HK, Mamon HJ, Ryan DP, et al: Toxicity and outcomes after chemoradiation for esophageal cancer in patients age 75 or older. Dis Esophagus. 23:316–323. 2010. View Article : Google Scholar : PubMed/NCBI
16	Servagi-Vernat S, Bosset M, Crehange G, et al: Feasibility of chemoradiotherapy for oesophageal cancer in elderly patients aged >or=75 years: a prospective, single-arm phase II study. Drug Aging. 26:255–262. 2009.
17	Herskovic A, Martz K, al-Sarraf M, et al: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 326:1593–1598. 1992. View Article : Google Scholar : PubMed/NCBI
18	Cooper JS, Guo MD, Herskovic A, et al: Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group. JAMA. 281:1623–1627. 1999. View Article : Google Scholar : PubMed/NCBI
19	Anderson SE, Minsky BD, Bains M, Hummer A, Kelsen D and Ilson DH: Combined modality chemoradiation in elderly oesophageal cancer patients. Br J Cancer. 96:1823–1827. 2007. View Article : Google Scholar : PubMed/NCBI
20	Tougeron D, Hamidou H, Scotté M, Di Fiore F, Antonietti M, Paillot B and Michel P: Esophageal cancer in the elderly: an analysis of the factors associated with treatment decisions and outcomes. BMC Cancer. 10:5102010. View Article : Google Scholar : PubMed/NCBI
21	Tougeron D, Di Fiore F, Thureau S, et al: Safety and outcome of definitive chemoradiaotherapy in elderly patients with oesophageal cancer. Br J Cancer. 99:1586–1592. 2008. View Article : Google Scholar : PubMed/NCBI
22	Go SI, Sup Lee W, Hee Kang M, et al: Response to concurrent chemoradiotherapy as a prognostic marker in elderly patients with locally advanced esophageal cancer. Tumori. 98:225–232. 2012.PubMed/NCBI
23	Coia LR, Minsky BD, Berkey BA, et al: Outcome of patients receiving radiation for cancer of the esophagus: results of the 1992–1994 Patterns of Care Study. J Clin Oncol. 18:455–462. 2000.
24	Polee MB, Hop WC, Kok TC, et al: Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy. Br J Cancer. 89:2045–2050. 2003. View Article : Google Scholar : PubMed/NCBI
25	Rohatgi P, Swisher SG, Correa AM, et al: Characterization of pathologic complete response after preoperative chemoradiotherapy in carcinoma of the esophagus and outcome after pathologic complete response. Cancer. 104:2365–2372. 2005. View Article : Google Scholar
26	Di Fiore F, Lecleire S, Rigal O, et al: Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma. World J Gastroenterol. 12:4185–4190. 2006.PubMed/NCBI
27	Takeuchi S, Ohtsu A, Doi T, et al: A retrospective study of definitive chemoradiotherapy for elderly patients with esophageal cancer. Am J Clin Oncol. 30:607–611. 2007. View Article : Google Scholar : PubMed/NCBI