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van der Poort EKJ, van Holstein Y, Slingerland M, Trompet S, van den Bos F, Portielje JEA, Steyerberg EW, van den Akker-van Marle ME, Bos WJW, Mooijaart SP, van den Hout WB. Allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer: An observational cohort study. J Geriatr Oncol 2024:102046. [PMID: 39138114 DOI: 10.1016/j.jgo.2024.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/14/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The Value-Based Health Care (VBHC) model of care provides insights into patient characteristics, outcomes, and costs of care delivery that help clinicians counsel patients. This study compares the allocation and value of curative oncological treatment in frail and fit older patients with esophageal cancer in a dedicated VBHC pathway. MATERIALS AND METHODS Data was collected from patients with primary esophageal cancer without distant metastases, aged 70 years or older, and treated at a Dutch tertiary care hospital between 2015 and 2019. Geriatric assessment (GA) was performed. Outcomes included treatment discontinuation, mortality, quality of life (QoL), and physical functioning over a one-year period. Direct hospital costs were estimated using activity-based costing. RESULTS In this study, 89 patients were included with mean age 75 years. Of 56 patients completing GA, 19 were classified as frail and 37 as fit. For frail patients, the treatment plan was chemoradiotherapy and surgery (CRT&S) in 68% (13/19) and definitive chemoradiotherapy (dCRT) in 32% (6/19); for fit patients, CRT&S in 84% (31/37) and dCRT in 16% (6/37). Frail patients discontinued chemotherapy more often than fit patients (26% (5/19) vs 11% (4/37), p = 0.03) and reported lower QoL after six months (mean 0.58 [standard deviation (SD) 0.35] vs 0.88 [0.25], p < 0.05). After one year, 11% of frail and 30% of fit patients reported no decline in physical functioning and QoL and survived. Frail and fit patients had comparable mean direct hospital costs (€24 K [SD €13 K] vs €23 K [SD €8 K], p = 0.82). DISCUSSION The value of curative oncological treatment was lower for frail than for fit patients because of slightly worse outcomes and comparable costs. The utility of the VBHC model of care depends on the availability of sufficient data. Real-world evidence in VBHC can be used to inform treatment decisions and optimization in future patients by sharing results and monitoring performance over time. TRIAL REGISTRATION The study was retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107 (date of registration: 22-10-2019).
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Affiliation(s)
- Esmée K J van der Poort
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands.
| | - Yara van Holstein
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Johanneke E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | | | - Willem Jan W Bos
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; Department of Internal Medicine, St. Antonius Hospital, Koekoekslaan 1, 3435CM Nieuwegein, the Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
| | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, the Netherlands
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Hirata K, Yoshida K, Katada C, Watanabe A, Tsushima T, Yamaguchi T, Yamamoto S, Ishikawa H, Sato Y, Imamura CK, Tanigawara Y, Ito Y, Kato K, Kitagawa Y, Hamamoto Y. Definitive chemoradiotherapy with paclitaxel for locally advanced esophageal squamous cell carcinoma in older patients (PARADISE-1): a phase I trial. BMC Cancer 2024; 24:873. [PMID: 39030570 PMCID: PMC11264717 DOI: 10.1186/s12885-024-12653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/17/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND In older patients, esophageal squamous cell carcinoma (ESCC) is difficult to treat using standard therapies, including surgery and cisplatin-based chemoradiotherapy. Paclitaxel (PTX) has radiosensitizing activity. We conducted a phase I trial of PTX combined with radiotherapy to establish a standard therapy for locally advanced ESCC in older patients. METHODS Enrollment was conducted at six centers in Japan from April 2016 to September 2019. The participants were aged ≥ 70 years, had locally advanced ESCC, and were intolerant to surgery or unwilling. A fixed 60-Gy radiation dose was administered in 30 fractions. PTX dosing levels started at 30 mg/m2 weekly for 6 weeks. Depending on the number of DLTs, the dose was set to be increased by 10 mg/m2 or switched to biweekly. A geriatric assessment was performed before treatment using the Geriatric-8 screening tool. The primary endpoint was dose-limiting toxicity (DLT). RESULTS We enrolled 24 patients (6 per group); DLT was observed in one (grade 4 hypokalemia), one (grade 3 aspiration), two (grade 3 radiodermatitis, grade 3 esophageal hemorrhage), and two (grade 3 anorexia, grade 5 pneumonitis) patients in the weekly PTX 30, 40, 50, and 60 mg/m2 groups, respectively. All adverse events, except death in the 60 mg/m2 group, showed reversible improvement, and the safety profile was considered acceptable. The 2-year survival and complete response rates were 40.0% and 54.2%, respectively. There was a significant difference in survival between favorable and unfavorable Geriatric-8 scores. CONCLUSIONS The recommended PTX dose with concomitant radiation was determined to be 50 mg/m2 weekly. Phase II trials at this dose are underway.
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Affiliation(s)
- Kenro Hirata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
- Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kayo Yoshida
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takahiro Tsushima
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 , Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Toshifumi Yamaguchi
- Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-Cho, Takatsuki, Osaka, 569-8686, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 1-3-3Higashinari-Ku, NakamichiOsaka, 537-8511, Japan
| | - Hideki Ishikawa
- Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 3-2-17-2F Imabashi, Chuo-Ku, Osaka, 541-0042, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Chiyo K Imamura
- Advanced Cancer Translational Research Institute, Showa University, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yusuke Tanigawara
- Laboratory of Pharmacometrics and Systems Pharmacology, Keio Frontier Research & Education Collaborative Square at Tonomachi, Keio University, 3-25-10 Tonomachi, Kawasaki-Ku, Kawasaki, Kanagawa, 210-0821, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Yasuo Hamamoto
- Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
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Lv X, Wu X, Liu K, Zhao X, Pan C, Zhao J, Chang J, Guo H, Gao X, Zhi X, Ren C, Chen Q, Jiang H, Wang C, Li Y. Development and Validation of a Nomogram Model for the Risk of Cardiac Death in Patients Treated with Chemotherapy for Esophageal Cancer. Cardiovasc Toxicol 2023; 23:377-387. [PMID: 37804372 DOI: 10.1007/s12012-023-09807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/05/2023] [Indexed: 10/09/2023]
Abstract
The primary cause of mortality in esophageal cancer survivors is cardiac death. Early identification of cardiac mortality risk during chemotherapy for esophageal cancer is crucial for improving the prognosis. We developed and validated a nomogram model to identify patients with high cardiac mortality risk after chemotherapy for esophageal cancer for early screening and clinical decision-making. We randomly allocated 37,994 patients with chemotherapy-treated esophageal cancer into two groups using a 7:3 split ratio: model training (n = 26,598) and validation (n = 11,396). 5- and 10-year survival rates were used as endpoints for model training and validation. Decision curve analysis and the consistency index (C-index) were used to evaluate the model's net clinical advantage. Model performance was evaluated using receiver operating characteristic curves and computing the area under the curve (AUC). Kaplan-Meier survival analysis based on the prognostic index was performed. Patient risk was stratified according to the death probability. Age, surgery, sex, and year were most closely related to cardiac death and used to plot the nomograms. The C-index for the training and validation datasets were 0.669 and 0.698, respectively, indicating the nomogram's net clinical advantage in predicting cardiac death risk at 5 and 10 years. The 5- and 10-year AUCs were 0.753 and 0.772 for the training dataset and 0.778 and 0.789 for the validation dataset, respectively. The accuracy of the model in predicting cardiac death risk was moderate. This nomogram can identify patients at risk of cardiac death after chemotherapy for esophageal cancer at an early stage.
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Affiliation(s)
- Xinfang Lv
- Department of Geriatrics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou City, Gansu Province, China
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xue Wu
- Department of Cardiology, The Second Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Kai Liu
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xinke Zhao
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chenliang Pan
- Cardiovascular Disease Center, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
| | - Jing Zhao
- Cardiovascular Disease Center, The First Hospital of Lanzhou University, Lanzhou City, Gansu Province, China
| | - Juan Chang
- Department of Traditional Medicine, Gansu Provincial Hospital, Lanzhou City, Gansu Province, China
| | - Huan Guo
- Center for Translational Medicine, Gansu Provincial Academic Institute for Medical Research, Lanzhou City, Gansu Province, China
| | - Xiang Gao
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Xiaodong Zhi
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chunzhen Ren
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Qilin Chen
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Hugang Jiang
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Chunling Wang
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China
| | - Yingdong Li
- School of Integrative Medicine, Gansu University of Chinese Medicine, Lanzhou City, Gansu Province, China.
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Wang J, Peng J, Luo H, Song Y. Development and internal validation of a nomogram for predicting survival of nonoperative EGFR-positive locally advanced elderly esophageal cancers. Front Oncol 2023; 13:1097907. [PMID: 37251922 PMCID: PMC10213387 DOI: 10.3389/fonc.2023.1097907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose This study aims to develop and validate a prediction model for non-operative, epidermal growth factor receptor (EGFR)-positive, locally advanced elderly esophageal cancer (LAEEC). Methods A total of 80 EGFR-positive LAEEC patients were included in the study. All patients underwent radiotherapy, while 41 cases received icotinib concurrent systemic therapy. A nomogram was established using univariable and multivariable Cox analyses. The model's efficacy was assessed through area under curve (AUC) values, receiver operating characteristic (ROC) curves at different time points, time-dependent AUC (tAUC), calibration curves, and clinical decision curves. Bootstrap resampling and out-of-bag (OOB) cross-validation methods were employed to verify the model's robustness. Subgroup survival analysis was also conducted. Results Univariable and multivariable Cox analyses revealed that icotinib, stage, and ECOG score were independent prognostic factors for LAEEC patients. The AUCs of model-based prediction scoring (PS) for 1-, 2-, and 3-year overall survival (OS) were 0.852, 0.827, and 0.792, respectively. Calibration curves demonstrated that the predicted mortality was consistent with the actual mortality. The time-dependent AUC of the model exceeded 0.75, and the internal cross-validation calibration curves showed good agreement between predicted and actual mortality. Clinical decision curves indicated that the model had a substantial net clinical benefit within a threshold probability range of 0.2 to 0.8. Model-based risk stratification analysis demonstrated the model's excellent ability to distinguish survival risk. Further subgroup analyses showed that icotinib significantly improved survival in patients with stage III and ECOG score of 1 (HR 0.122, P<0.001). Conclusions Our nomogram model effectively predicts the overall survival of LAEEC patients, and the benefits of icotinib were found in the clinical stage III population with good ECOG scores.
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Affiliation(s)
| | | | | | - Yaqi Song
- *Correspondence: Yaqi Song, ; Honglei Luo,
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Saito Y, Hamamoto Y, Hirata K, Yamasaki M, Watanabe M, Abe T, Tsubosa Y, Hamai Y, Murakami K, Bamba T, Yoshii T, Tsuda M, Watanabe M, Ueno M, Kitagawa Y. Real-world management and outcomes of older patients with locally advanced esophageal squamous cell carcinoma: a multicenter retrospective study. BMC Cancer 2023; 23:283. [PMID: 36978040 PMCID: PMC10053162 DOI: 10.1186/s12885-023-10710-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Neoadjuvant chemotherapy (NAC) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Chemoradiotherapy (CRT) is an alternative treatment approach. However, both treatments are associated with toxicity, and the optimal treatment for older patients with ESCC is unknown. This study aimed to evaluate the treatment strategies and prognosis of older patients with locally advanced ESCC in a real-world setting.
Methods
We retrospectively evaluated 381 older patients (≥ 65 years) with locally advanced ESCC (stage IB/II/III, excluding T4) who received anticancer therapy at 22 medical centers in Japan. Based on age, performance status (PS), and organ function, the patients were classified into two groups: clinical trial eligible and ineligible groups. Patients aged ≤ 75 years with adequate organ function and a PS of 0–1 were categorized into the eligible group. We compared the treatments and prognoses between the two groups.
Results
The ineligible group had significantly shorter overall survival (OS) than the eligible group (hazard ratio [HR] for death, 1.65; 95% confidence interval [CI], 1.22–2.25; P = 0.001). The proportion of patients receiving NAC followed by surgery was significantly higher in the eligible group than in the ineligible group (P = 1.07 × 10–11), whereas the proportion of patients receiving CRT was higher in the ineligible group than in the eligible group (P = 3.09 × 10–3). Patients receiving NAC followed by surgery in the ineligible group had comparable OS to those receiving the same treatment in the eligible group (HR, 1.02; 95% CI, 0.57–1.82; P = 0.939). In contrast, patients receiving CRT in the ineligible group had significantly shorter OS than those receiving CRT in the eligible group (HR, 1.85; 95% CI, 1.02–3.37; P = 0.044). In the ineligible group, patients receiving radiation alone had comparable OS to those receiving CRT (HR, 1.13; 95% CI, 0.58–2.22; P = 0.717).
Conclusions
NAC followed by surgery is justified for select older patients who can tolerate radical treatment, even if they are old or vulnerable to enrollment in clinical trials. CRT did not provide survival benefits over radiation alone in patients ineligible for clinical trials, suggesting the need to develop less-toxic CRT.
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Zhang G, Yuan J, Pan C, Xu Q, Cui X, Zhang J, Liu M, Song Z, Wu L, Wu D, Luo H, Hu Y, Jiao S, Yang B. Multi-omics analysis uncovers tumor ecosystem dynamics during neoadjuvant toripalimab plus nab-paclitaxel and S-1 for esophageal squamous cell carcinoma: a single-center, open-label, single-arm phase 2 trial. EBioMedicine 2023; 90:104515. [PMID: 36921563 PMCID: PMC10024111 DOI: 10.1016/j.ebiom.2023.104515] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors combined with chemotherapy as a neoadjuvant therapy have been applied to the treatment of esophageal squamous cell carcinoma (ESCC). However, the optimal regimen needs to be further explored, particularly for older patients, and the mechanisms by which the immune checkpoint inhibitor combined with chemotherapy modulates the evolution of ESCC are unknown. METHODS In this single-arm phase 2 trial, patients with resectable (stage II/III/IV without metastasis) ESCC were enrolled and received nanoparticle albumin-bound (nab) paclitaxel for two cycles and oral S-1 for 2 weeks, combined with intravenous toripalimab for two cycles before surgery. Combination postoperative adjuvant therapy was administered. The primary outcome was the major pathological response (MPR). Secondary outcomes included pathological complete response (pCR), overall response rate (ORR), disease control rate (DCR), disease-free survival (DFS), overall survival (OS), improvement in Stooler's dysphagia score and degree of daily living ability (dADL). Biopsies and plasma pre- and post-neoadjuvant therapy were performed using whole-exome sequencing, transcriptome sequencing, immunohistochemistry (IHC) for PD-L1, multiplex immunofluorescence (mIF) and proximity extension assay technology (PEA) for 92 proteins. FINDINGS From November 2019 to July 2021, 60 patients were enrolled. After neoadjuvant therapy, R0 resection was achieved in 55 (98.21%) patients. MPR was identified in 27 patients (49.09%), and 16 patients (29.09%) achieved pCR. Patients with PR, SD and PD were 37 (61.67%), 21 (35.00%) and 2 (3.33%), respectively. The overall staging, Stooler dysphagia scores and dADL were significantly decreased after treatment. 11 patients (18.3%) experienced grade ≥3 AEs. Compared to PD-L1-Low patients, PD-L1-High patients had a significantly higher ratio of PR. During therapy, the tumor mutation burden (TMB) and tumor neoantigen burden (TNB) were significantly decreased in patients with PR. Differential clonal evolution within tumors was demonstrated by analysis of intratumoral heterogeneity. Transcriptome analyses revealed that the infiltration of CD4+ T lymphocytes at baseline was associated with clinical outcome. During therapy, CD8+ T cells and CD4+ T cells were increased in all patients; however, exhausted cells, nTregs and iTregs were significantly increased in patients with non-MPR. Protein analyses revealed that the levels of IFN-γ, Gal.1 and LAMP3 can predict the clinical benefit. In addition, the expression of CD83, TNFRSF4, TNFSF14, VEGFR2, ADA, ARG1, and HO-1 was associated with serious AEs. More importantly, the integration of CD4+ T cells with plasma protein of IFN-γ, Gal.1 or LAMP3 could further distinguish responders from non-responders. INTERPRETATION In this study, neoadjuvant therapy with toripalimab, nab-paclitaxel and S-1 was less toxic and showed promising antitumor activity in patients with resectable ESCC. Changes in the genome, transcriptome, PD-L1 expression and serum proteins were comprehensively analyzed and correlated with clinical outcomes, which provides insight into the mechanism of action of toripalimab combined with nab-paclitaxel and S-1 in patients with ESCC. FUNDING This study was funded by Major projects of the ministry of science and technology of the 13th five-year plan of China [grant number: 2018ZX09201013].
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Affiliation(s)
- Guoqing Zhang
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Yuan
- Department of Pathology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chaohu Pan
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Qing Xu
- Department of Nutrition, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoli Cui
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Jing Zhang
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minglu Liu
- Outpatient Department, Jingnan Medical Area, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Song
- Department of Pathology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liangliang Wu
- Institute of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongfang Wu
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China
| | - Haitao Luo
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and Therapy, YuceBio Technology Co., Ltd, Shenzhen, China.
| | - Yi Hu
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Shunchang Jiao
- Department of Oncology, Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
| | - Bo Yang
- Department of Thoracic Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
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Kiladze I, Chkhaidze L, Iovashvili A, Natelauri E, Sokurashvili B, Mariamidze E, Kacheishvili N, Jeremic B. Definitive chemoradiotherapy in elderly patients with esophageal cancer: Safety and outcome. PRECISION RADIATION ONCOLOGY 2023. [DOI: 10.1002/pro6.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Yu N, Cheng G, Li J, Liang J, Zhang T, Deng L, Liu W, Wang J, Zhai Y, Wang W, Xiao Z, Zhou Z, Chen D, Feng Q, Bi N, Wang X. Efficacy and Safety of Concurrent Chemoradiotherapy Combined with Nimotuzumab in Elderly Patients with Esophageal Squamous Cell Carcinoma: A Prospective Real-world Pragmatic Study. Curr Cancer Drug Targets 2023; 23:653-662. [PMID: 36924100 DOI: 10.2174/1568009623666230315145937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/02/2022] [Accepted: 01/11/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Concurrent or definitive chemoradiotherapy is the standard treatment of locally advanced esophageal squamous cell carcinoma (ESCC). Elderly patients could not tolerate the standard concurrent chemotherapy and were treated with radiotherapy because of weak physical status and multiple comorbidities. OBJECTIVE The efficacy and safety profile of concurrent (chemo) radiotherapy combined with nimotuzumab in elderly patients with ESCC were investigated. METHODS Eligible elderly (≥70 years) patients with locally advanced ESCC were enrolled in this prospective, real-world pragmatic study and received concurrent chemoradiotherapy or radiotherapy combined with nimotuzumab. The primary endpoint was overall survival (OS). Secondary endpoints were objective response rate, disease control rate, progression-free survival (PFS), and adverse drug reactions. RESULTS Fifty-three elderly patients were enrolled. Thirty-two (60.4%) were treated with radiotherapy combined with nimotuzumab (RT+N), and 21 (39.6%) with concurrent chemoradiotherapy combined with nimotuzumab (CRT+N). The median age was 75.8 years. Fourteen (56.0%) patients achieved a partial response, and 11 (44.0%) patients achieved stable disease at 3 months. The median follow-up duration was 24.4 (95%CI, 21.6-26.7) months. Median OS (mOS) was 27.0 (95%CI, 14.8-48.4) months. Median PFS (mPFS) was 22.6 (95%CI, 12.4-not reached) months. Higher mPFS (not reached vs. 12.0 months; p=0.022) and mOS (48.4 vs. 15.3 months; p=0.009) were observed in the CRT+N group compared with the RT+N group. Most adverse reactions were grade 1-2 (46, 86.8%). CONCLUSIONS Concurrent chemoradiotherapy or radiotherapy combined with nimotuzumab was safe and well-tolerated in elderly patients with locally advanced ESCC. ESCC patients treated with CRT+N could live longer.
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Affiliation(s)
- Nuo Yu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Guowei Cheng
- Department of Radiation Oncology, Cancer Hospital of HuanXing, Beijing, China
| | - Jiao Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenyang Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianyang Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yirui Zhai
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenqing Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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9
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Roeder F, Jensen AD, Lindel K, Mattke M, Wolf F, Gerum S. Geriatric Radiation Oncology: What We Know and What Can We Do Better? Clin Interv Aging 2023; 18:689-711. [PMID: 37168037 PMCID: PMC10166100 DOI: 10.2147/cia.s365495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Elderly patients represent a growing subgroup of cancer patients for whom the role of radiation therapy is poorly defined. Older patients are still clearly underrepresented in clinical trials, resulting in very limited high-level evidence. Moreover, elderly patients are less likely to receive radiation therapy in similar clinical scenarios compared to younger patients. However, there is no clear evidence for a generally reduced radiation tolerance with increasing age. Modern radiation techniques have clearly reduced acute and late side effects, thus extending the boundaries of the possible regarding treatment intensity in elderly or frail patients. Hypofractionated regimens have further decreased the socioeconomic burden of radiation treatments by reducing the overall treatment time. The current review aims at summarizing the existing data for the use of radiation therapy or chemoradiation in elderly patients focusing on the main cancer types. It provides an overview of treatment tolerability and outcomes with current standard radiation therapy regimens, including possible predictive factors in the elderly population. Strategies for patient selection for standard or tailored radiation therapy approaches based on age, performance score or comorbidity, including the use of prediction tests or geriatric assessments, are discussed. Current and future possibilities for improvements of routine care and creation of high-level evidence in elderly patients receiving radiation therapy are highlighted.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
- Correspondence: Falk Roeder, Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Müllner Hauptstrasse 48, Salzburg, 5020, Austria, Tel +43 57255 55569, Email
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospital Marburg-Giessen, Giessen, Germany
| | - Katja Lindel
- Department of Radiation Oncology, Städtisches Klinikum, Karlsruhe, Germany
| | - Matthias Mattke
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Frank Wolf
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
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10
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The Role of Age and Comorbidities in Esophagogastric Cancer Chemoradiation of the Frail Elderly (>70 Years): An Analysis from a Tertiary High Volume-Center. Cancers (Basel) 2022; 15:cancers15010106. [PMID: 36612103 PMCID: PMC9817865 DOI: 10.3390/cancers15010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Elderly patients > 70 years of age with esophageal cancer (EC) represent a challenging group as frailty and comorbidities need to be considered. The aim of this retrospective study was to evaluate the efficacy and side effects of curative chemoradiation therapy (CRT) with regard to basic geriatric screening in elderly patients in order to elucidate prognostic factors. Thirty-four elderly patients > 70 years with EC treated at our cancer center between May 2014 and October 2018 fulfilled the selection criteria for this retrospective analysis. Treatment consisted of intravenous infusion of carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. Clinicopathological data including performance status (ECOG), (age-adjusted) Charlson comorbidity index (CCI), Frailty-scale by Fried, Mini Nutritional Assessment Short Form, body mass index, C-reactive protein to albumin ratio, and treatment-related toxicity (CTCAE) were assessed. Data were analyzed as predictors of overall survival (OS) and progression-free survival (PFS). All patients (ten female, 24 male) received combined CRT (22 patients in neoadjuvant, 12 patients in definite intent). Median age was 75 years and the ECOG index between 0 and 1 (52.9% vs. 35.3%); four patients were rated as ECOG 3 (11.8%). Median follow-up was 24 months. Tumors were mainly located in the lower esophagus or esophagogastric-junction with an T3 stage (n = 25; 75.8%) and N1 stage (n = 28; 90.3%). 15 patients (44.1%) had SCC, 19 patients (55.9%) AC. 26 of the patients (76.5%) were scored as prefrail and 50% were in risk for malnutrition (n = 17). In relation to the BMI, ten patients (29.4%) were ranked as overweight, and 15 patients were presented in a healthy state of weight (44.1%). Grade 3 acute toxicity (or higher) occured in nine cases (26.5%). Most of the patients did not show any late toxicities (66.7%). Trimodal therapy provides a significant prolonged OS (p = 0.049) regardless of age, but without impact on PFS. Our analysis suggests that chemoradiation therapy is feasible for elderly patients (>70 years) with tolerable toxicity. Trimodal therapy of EC shows a positive effect on OS and PFS. Further studies are needed to elucidate benefitting subgroups within the elderly. In addition to age, treatment decisions should be based on performance status, nutritional condition and multidisciplinary validated geriatric screening tools.
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11
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Hamamoto Y, Murakami K, Kato K, Kitagawa Y. Management of elderly patients with esophageal squamous cell cancer. Jpn J Clin Oncol 2022; 52:816-824. [PMID: 35511482 PMCID: PMC9354502 DOI: 10.1093/jjco/hyac067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
This review focuses on the treatment about elderly esophageal cancer to clarify the current situation regarding our clinical question. Although there are several reviews about elderly esophageal cancer treatment, there are fundamental differences between Japan and the rest of the world. Two main differences are raised: histological differences and treatment strategies for resectable patients. We overview each status according to following clinical questions. First, there are no established evaluation criteria for frail. Second, selection criteria for surgery or non-surgery are not established. Third, few specific treatments for elderly patients (EPs) are investigated. In conclusion, there are many reports about treatment of esophageal squamous cell carcinoma for EPs, although treatment strategy is still controversial. We have to consider well-designed prospective trial to confirm specific treatment strategy according to each stage.
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Affiliation(s)
- Yasuo Hamamoto
- Keio Cancer Center, Keio University Hospital, School of Medicine, Tokyo, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Miyata J, Yamazaki M, Ueda Y. Complete remission after concurrent single-agent S-1 chemoradiotherapy for stage IIIB esophageal cancer: an autopsy case report. Clin J Gastroenterol 2022; 15:688-693. [PMID: 35461381 DOI: 10.1007/s12328-022-01634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
Chemoradiotherapy regimens for patients with esophageal cancer intolerant to standard therapies remain to be established. The standard therapy for patients with stage II-III esophageal squamous cell carcinoma, who are not surgical candidates, is definitive chemoradiotherapy with concomitant use of 5-fluorouracil and cisplatin; however, cisplatin can cause serious adverse events. An 83-year-old Japanese man developed a 2-month history of nausea and vomiting. Contrast-enhanced computed tomography revealed concentric wall thickening in the mid-to-lower esophagus with surrounding regional lymph node swelling. Upper gastrointestinal endoscopy revealed an ulcerated tumor with raised margins in the middle esophagus. He was diagnosed with stage IIIB (T3N2M0) esophageal squamous cell carcinoma, pathologically exhibiting squamous epithelium-like invasive abnormal structure with atypical cells. He underwent chemoradiotherapy involving four-dimensional conformal radiotherapy and single-agent S-1 rather than the standard chemoradiotherapy, and achieved clinical remission 2 months later on endoscopy and computed tomography. The patient died 1 year later due to pneumonia, and the autopsy did not reveal any evidence of squamous cell carcinoma in the esophagus, surrounding lymph nodes, or other organs, suggesting pathologically complete remission. Concurrent single-agent S-1 chemoradiotherapy may induce complete remission of stage IIIB esophageal cancer and is a possible alternative for older patients or those with multiple comorbidities.
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Affiliation(s)
- Jun Miyata
- Department of Family Medicine, Medical Center for the Entire Family, Keiju Medical Center, 94 Tomiokacho, Nanao, Ishikawa, 926-8605, Japan.
| | - Masahide Yamazaki
- Department of Internal Medicine, Keiju Medical Center, 94 Tomiokacho, Nanao, Ishikawa, 926-8605, Japan
| | - Yoshimichi Ueda
- Department of Pathology II, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, 920-0293, Japan
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13
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Liu Y, Zheng Z, Li M, Zhang Y, Zhao F, Gong H, Lin H, Huang W, Chen X, Xu Z, Li X, Liu W, Cui Y, Zheng A, Li B. Comparison of Concurrent Chemoradiotherapy with Radiotherapy Alone for Locally Advanced Esophageal Squamous Cell Cancer in Elderly Patients: A Randomized, Multicenter, Phase II Clinical Trial. Int J Cancer 2022; 151:607-615. [PMID: 35419831 DOI: 10.1002/ijc.34030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022]
Abstract
This randomized, multicenter, phase II clinical trial was performed to compare the safety and efficacy of concurrent chemoradiotherapy using S-1 (CCRT) with radiotherapy alone (RT) for elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). All eligible patients were randomly assigned to the CCRT group or the RT group at a 1:1 ratio. The CCRT group received 50.4 Gy radiotherapy concurrent with S-1 and the RT group received 59.4 Gy radiotherapy alone. The primary endpoints were toxicity and the overall response rate (ORR), and the secondary endpoints were overall survival (OS) and progression-free survival (PFS). In total, 157 elderly patients with ESCC were recruited from December 2016 to March 2020. By June 2021, the median follow-up duration had reached 38 months. No grade 5 toxicities occurred in either group and the overall rate of severe toxicities (≥grade 3) was higher in the CCRT group (19.2% to 7.6%; p=0.037), particularly neutropenia (7.7% vs. 1.3%; p=0.06). The CCRT group presented a significantly higher ORR (83.3% vs. 68.4%; p=0.009) and prolonged PFS (25.7 months vs.13.9 months; p=0.026) than the RT group. The median OS was 27.3 months in the CCRT group and 19.1 months in the RT group (p=0.59). For patients older than 70 years with locally advanced ESCC, concurrent chemoradiotherapy with S-1 had tolerable adverse effects and improved ORR and PFS compared with radiotherapy alone.
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Affiliation(s)
- Yanxiao Liu
- Department of Graduate, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhiyong Zheng
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Minghao Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yaowen Zhang
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Fujun Zhao
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Heyi Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Haiqun Lin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Wei Huang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xiangming Chen
- Department of Clinical Oncology, Taian City Central Hospital, Taian, Shandong, China
| | - Zhiqiao Xu
- Tumor Diagnosis and Treatment Center, Kaifeng Central Hospital, Kaifeng, Henan, China
| | - Xiaomin Li
- Department of Radiation Oncology, Shanxi cancer hospital, Taiyuan, Shanxi, China
| | - Wenzhi Liu
- Department of Clinical Oncology, Taian City Central Hospital, Taian, Shandong, China
| | - Yanhui Cui
- Radiation Therapy Department, 1 Ward of the First Affiliated Hospital of Xinxiang, Weihui, Henan, China
| | - Anping Zheng
- Department of Radiation Oncology, Anyang tumor hospital, The fourth affiliated hospital of Henan University of science and technology, Anyang, China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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14
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van Holstein Y, Trompet S, van Deudekom FJ, van Munster B, de Glas NA, van den Bos F, Uit den Boogaard A, van der Elst MJT, van der Kaaij MAE, Neelis KJ, Langers AMJ, Slingerland M, Portielje JEA, Mooijaart SP. Geriatric assessment and treatment outcomes in a Dutch cohort of older patients with potentially curable esophageal cancer. Acta Oncol 2022; 61:459-467. [PMID: 35193449 DOI: 10.1080/0284186x.2022.2036366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with potentially curable esophageal cancer can be treated with neo-adjuvant chemoradiotherapy followed by surgery or definitive chemoradiotherapy with curative intent. For frail older patients choosing the appropriate oncological treatment can be difficult, and data on geriatric deficits as determinants of treatment outcomes are not yet available. OBJECTIVES To describe the prevalence of geriatric deficits and to study their association with treatment discontinuation and mortality in older patients with potentially curable esophageal cancer. MATERIAL AND METHODS A cohort study was conducted in a Dutch tertiary care hospital including patients aged ≥70 years with primary stage I-IVA esophageal cancer. Geriatric screening and assessment data were collected. Outcomes were treatment discontinuation and one year all-cause mortality. RESULTS In total, 138 patients with curable esophageal cancer were included. Mean age was 76.1 years (standard deviation 4.7), 54% had clinical stage III and 24% stage IVA disease. Most patients received neo-adjuvant chemoradiotherapy and surgery (41%), 32% definitive chemoradiotherapy and 22% palliative radiotherapy. Overall, one year all-cause mortality was 36%. Geriatric screening and assessment was performed in 94 out of 138 patients, of which 60% was malnourished, 20% dependent in Instrumental Activities of Daily Living (IADL) and 52% was frail. Malnutrition was associated with higher mortality risk (Hazard Ratio, 3.2; 95% Confidence Interval, 1.3-7.7)) independent of age, sex and tumor stage. Seventy-six out of 94 patients were treated with chemoradiotherapy, of which 23% discontinued treatment. Patients with IADL dependency and Charlson Comorbidity Index ≥1 discontinued treatment more often. CONCLUSION All-cause mortality within one year was high, irrespective of treatment modality. Treatment discontinuation rate was high, especially in patients treated with definitive chemoradiotherapy. Geriatric assessment associates with outcomes in older patients with esophageal cancer and may inform treatment decisions and optimization in future patients, but more research is needed to establish its predictive value. Trial registration: The study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107. Date of registration: 22-10-2019.
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Affiliation(s)
- Yara van Holstein
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Stella Trompet
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Floor J. van Deudekom
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Barbara van Munster
- Department of Internal Medicine, University Medical Center Groningen, The Netherlands
| | - Nienke A. de Glas
- Department of Medical Oncology, Leiden University Medical Center, The Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Anna Uit den Boogaard
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | - Marjan J. T. van der Elst
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
| | | | - Karen J. Neelis
- Department of Radiation Oncology, Leiden University Medical Center, The Netherlands
| | - Alexandra M. J. Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| | - Marije Slingerland
- Department of Medical Oncology, Leiden University Medical Center, The Netherlands
| | | | - Simon P. Mooijaart
- Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, The Netherlands
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15
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Schweizer C, Fietkau R, Putz F. [Profound survival benefit with concurrent chemotherapy: insights from a Chinese phase III trial in older patients with esophageal cancer]. Strahlenther Onkol 2022; 198:500-502. [PMID: 35286400 PMCID: PMC9038893 DOI: 10.1007/s00066-022-01921-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Claudia Schweizer
- Strahlenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Deutschland
| | - Rainer Fietkau
- Strahlenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Deutschland
| | - Florian Putz
- Strahlenklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Deutschland.
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16
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Guo S, Liu F, Liu H, Wu Y, Zhang X, Ye W, Luo G, Li Q, Chen N, Hu N, Wang B, Zhang J, Lin M, Feng H, Qiu B. A Prospective Phase II Study of Simultaneous Modulated Accelerated Radiotherapy Concurrently With CDDP/S1 for Esophageal Squamous Cell Carcinoma in the Elderly. Front Oncol 2021; 11:760631. [PMID: 34900709 PMCID: PMC8654786 DOI: 10.3389/fonc.2021.760631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background To explore the efficacy and toxicity of simultaneous modulated accelerated radiotherapy (SMART) concurrently with cisplatin (CDDP) and S1 (tegafur/gimeracil/oteracil) in elderly patients with esophageal squamous cell carcinoma (ESCC). Methods This single-arm, phase II study enrolled pathologically confirmed, stage II-IVa ESCC of 70-80 years old and Eastern Cooperative Oncology Group performance status (ECOG PS) 0-2. Patients received SMART (64 Gy to gross tumor volume and 48 Gy to clinical target volume in 30 fractions) with concurrent CDDP (day 1 of each week) and S1 (days 1-14, 22-35). The primary endpoint was objective response rate (ORR). The secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicities. Results Thirty-seven eligible patients were analyzed with median follow-up of 25.7 months for all and 46.1 months for survivors. The ORR was 88.9%. Patients with baseline weight loss <5% (p=0.050) and nutritional risk index (NRI) ≥105.2 (p=0.023) had better tumor response. Median PFS was 13.8 months with 2-year PFS of 37.5%. Median OS was 27.7 months with 2-year OS of 57.5%. OS was significantly associated with ECOG PS (p=0.005), stage (p=0.014), gross tumor volume (p=0.004), baseline NRI (p=0.036), baseline C-reactive protein (CRP) level (p=0.003) and tumor response (p=0.000). CRP level (p=0.016) and tumor response (p=0.021) were independently prognostic of OS. ≥grade 3 anemia, neutropenia and thrombocytopenia occurred in 2.7%, 10.8% and 13.5% of patients; ≥grade 3 esophagitis and pneumonitis occurred in 18.9% and 2.7% of patient, respectively. Conclusion SMART concurrently with CDDP/S1 yielded satisfactory response rate, survival outcome and tolerable treatment-related toxicities in elderly patients with ESCC. Further studies are warranted to validate the results.
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Affiliation(s)
- SuPing Guo
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - FangJie Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - YingJia Wu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - XuHui Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - WenFeng Ye
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Clinical Nutrition, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - GuangYu Luo
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Endoscopy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - QiWen Li
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - NaiBin Chen
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Nan Hu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Bin Wang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jun Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - MaoSheng Lin
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - HuiXia Feng
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bo Qiu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Association Study of Thoracic Oncology, Guangzhou, China
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17
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Wu H, Yu Y, Zheng Q, Liu T, Wu Y, Wang Z, Zheng H, Liu L, Li J. Benefit of chemotherapy based on platinum with definitive radiotherapy in older patients with locally advanced esophageal squamous cell carcinoma. Radiat Oncol 2021; 16:207. [PMID: 34717670 PMCID: PMC8557531 DOI: 10.1186/s13014-021-01931-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
Objective 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. Methods 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. Results 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). Conclusions 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.
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Affiliation(s)
- Haishan Wu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Yilin Yu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Qunhao Zheng
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Tianxiu Liu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Yahua Wu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Zhiping Wang
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Hongying Zheng
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Lingyun Liu
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China
| | - Jiancheng Li
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, 350014, China.
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Ji Y, Du X, Zhu W, Yang Y, Ma J, Zhang L, Li J, Tao H, Xia J, Yang H, Huang J, Bao Y, Du D, Liu D, Wang X, Li C, Yang X, Zeng M, Liu Z, Zheng W, Pu J, Chen J, Hu W, Li P, Wang J, Xu Y, Zheng X, Chen J, Wang W, Tao G, Cai J, Zhao J, Zhu J, Jiang M, Yan Y, Xu G, Bu S, Song B, Xie K, Huang S, Zheng Y, Sheng L, Lai X, Chen Y, Cheng L, Hu X, Ji W, Fang M, Kong Y, Yu X, Li H, Li R, Shi L, Shen W, Zhu C, Lv J, Huang R, He H, Chen M. Efficacy of Concurrent Chemoradiotherapy With S-1 vs Radiotherapy Alone for Older Patients With Esophageal Cancer: A Multicenter Randomized Phase 3 Clinical Trial. JAMA Oncol 2021; 7:1459-1466. [PMID: 34351356 DOI: 10.1001/jamaoncol.2021.2705] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Most older patients with esophageal cancer cannot complete the standard concurrent chemoradiotherapy (CCRT). An effective and tolerable chemoradiotherapy regimen for older patients is needed. Objective To evaluate the efficacy and toxic effects of CCRT with S-1 vs radiotherapy (RT) alone in older patients with esophageal cancer. Design, Setting, and Participants A randomized, open-label, phase 3 clinical trial was conducted at 23 Chinese centers between June 1, 2016, and August 31, 2018. The study enrolled 298 patients aged 70 to 85 years. Eligible participants had histologically confirmed esophageal cancer, stage IB to IVB disease based on the 6th edition of the American Joint Committee on Cancer (stage IVB: only metastasis to the supraclavicular/celiac lymph nodes) and an Eastern Cooperative Oncology Group performance status of 0 to 1. Data analysis was performed from August 1, 2020, to March 10, 2021. Interventions Patients were stratified according to age (<80 vs ≥80 years) and tumor length (<5 vs ≥5 cm) and randomly assigned (1:1) to receive either CCRT with S-1 or RT alone. Main Outcomes and Measures The primary end point was the 2-year overall survival rate using intention-to-treat analysis. Results Of the 298 patients enrolled, 180 (60.4%) were men. The median age was 77 (interquartile range, 74-79) years in the CCRT group and 77 (interquartile range, 74-80) years in the RT alone group. A total of 151 patients (50.7%) had stage III or IV disease. The CCRT group had a significantly higher complete response rate than the RT group (41.6% vs 26.8%; P = .007). Surviving patients had a median follow-up of 33.9 months (interquartile range: 28.5-38.2 months), and the CCRT group had a significantly higher 2-year overall survival rate (53.2% vs 35.8%; hazard ratio, 0.63; 95% CI, 0.47-0.85; P = .002). There were no significant differences in the incidence of grade 3 or higher toxic effects between the CCRT and RT groups except that grade 3 or higher leukopenia occurred in more patients in the CCRT group (9.5% vs 2.7%; P = .01). Treatment-related deaths were observed in 3 patients (2.0%) in the CCRT group and 4 patients (2.7%) in the RT group. Conclusions and Relevance In this phase 3 randomized clinical trial, CCRT with S-1 was tolerable and provided significant benefits over RT alone in older patients with esophageal cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02813967.
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Affiliation(s)
- Yongling Ji
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xianghui Du
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Weiguo Zhu
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | | | - Jun Ma
- Anhui Provincial Hospital, Hefei, China
| | - Li Zhang
- Chongqing Sanxia Central Hospital, Chongqing, China
| | - Jiancheng Li
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Hua Tao
- Jiangsu Cancer Hospital, Nanjing, China
| | | | - Haihua Yang
- Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Jin Huang
- The First People's Hospital of Changzhou, Changzhou, China
| | - Yong Bao
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dexi Du
- Lishui Municipal Central Hospital, Lishui, China
| | - Degan Liu
- Xinghua City People's Hospital, Xinghua, China
| | | | | | - Xinmei Yang
- The First Hospital of Jiaxing, Jiaxing, China
| | - Ming Zeng
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhigang Liu
- The Fifth Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Wen Zheng
- Shangrao People's Hospital, Shangrao, China
| | - Juan Pu
- Lianshui County People's Hospital, Lianshui, China
| | - Jun Chen
- Yinzhou People's Hospital, Ningbo, China
| | - Wangyuan Hu
- Jinhua Municipal Central Hospital, Jinhua, China
| | - Peijing Li
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Yujin Xu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiao Zheng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Jianxiang Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Wanwei Wang
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Guangzhou Tao
- The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Cai
- Nantong Tumor Hospital, Nantong, China
| | | | - Jun Zhu
- Jiangsu Cancer Hospital, Nanjing, China
| | | | - Yan Yan
- Huaian Second People's Hospital, Huaian, China
| | - Guoping Xu
- The First People's Hospital of Changzhou, Changzhou, China
| | | | - Binbin Song
- The First Hospital of Jiaxing, Jiaxing, China
| | - Ke Xie
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Shan Huang
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Yuanda Zheng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Liming Sheng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiaojing Lai
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Ying Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Lei Cheng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiao Hu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Wenhao Ji
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Min Fang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Yue Kong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiaofu Yu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Huizhang Li
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Runhua Li
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Lei Shi
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Wei Shen
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Chaonan Zhu
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Junwei Lv
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Shanghai, China
| | - Rong Huang
- The First People's Hospital of Foshan, Foshan, China
| | - Han He
- The First People's Hospital of Foshan, Foshan, China
| | - Ming Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Kozuki R, Watanabe M, Toihata T, Takahashi K, Otake R, Okamura A, Imamura Y, Mine S. Treatment strategies and outcomes for elderly patients with locally advanced squamous cell carcinoma of the esophagus. Surg Today 2021; 52:377-384. [PMID: 34331129 DOI: 10.1007/s00595-021-02348-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A multidisciplinary treatment strategy for locally advanced esophageal squamous cell carcinoma (ESCC) is required to achieve prolonged survival. We aimed to clarify the differences in treatment strategies for locally advanced ESCC and the outcomes of elderly (aged ≥ 75 years) vs. younger patients (aged < 75 years). METHODS We compared the treatment strategy selection and the outcomes of 40 elderly and 160 younger patients with cStage II/III ESCC diagnosed between January, 2014 and December, 2016. RESULTS Nineteen (47.5%) of the elderly patients and 144 (90.0%) of the younger patients underwent esophagectomy and 9 (22.5%) of the elderly patients and 131 (81.9%) of the younger patients received neoadjuvant chemotherapy. Ivor-Lewis or transhiatal esophagectomy was performed more frequently in the elderly group than in the younger group (P = 0.0096). The survival rate after esophagectomy was higher in the younger group than in the elderly group. The overall survival rate of the elderly patients who underwent esophagectomy was significantly higher than that in those who did not. CONCLUSIONS Esophagectomy is a practical choice for elderly patients with locally advanced ESCC, although reduced treatment intensity may impact long-term survival.
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Affiliation(s)
- Ryotaro Kozuki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Reiko Otake
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis. Cancers (Basel) 2021; 13:cancers13092104. [PMID: 33925512 PMCID: PMC8123886 DOI: 10.3390/cancers13092104] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Any given treatment may provide improve survival for elderly patients with oesophageal cancer compared to best supportive care. Although surgery may be related to a higher rate of complications in these patients, it also offers the best chance for survival, especially when combined with perioperative chemo-or chemoradiation. Definitive chemoradiation remains also a valid and widely used curative approach in this population. Quality of life after oesophageal cancer treatment does not seem to be particularly compromised in elderly patients, although the risk of loss of autonomy after the disease is higher. Based on the available data, excluding a priori elderly patients from curative treatment based on age alone cannot be supported. A thorough general health status and geriatric assessment is necessary to offer the optimal treatment, tailored to the individual patient. Abstract 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.
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21
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Kawamoto T, Shikama N, Mine S, Tsurumaru M, Sasai K. Clinical impact of baseline renal function on the safety of radiotherapy with concurrent docetaxel for esophageal cancer in elderly patients. Esophagus 2020; 17:425-432. [PMID: 32170545 DOI: 10.1007/s10388-020-00731-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/04/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND We aimed to compare the safety of radiotherapy with concurrent docetaxel (DOC-RT) for esophageal cancer (EC) in elderly patients who were divided into a creatinine clearance (Ccr) < 60 mL/min (Ccr-L) group and a Ccr ≥ 60 mL/min (Ccr-H) group. METHODS Eligible patients included those aged ≥ 76 years who were diagnosed with esophageal squamous cell carcinoma. The patients received radiotherapy (60 Gy in 30 fractions) and concurrent docetaxel (10 mg/m2 weekly for six cycles), after which toxicity and treatment completion rates were retrospectively evaluated. RESULTS The 73 elderly EC patients receiving DOC-RT were divided into two groups for evaluation: the Ccr-L group (49 patients) and the Ccr-H group (24 patients). The median survival time for patients in the Ccr-L and Ccr-H groups was 21 and 20 months, respectively (p = 0.2). The incidence of grade 1 acute kidney injury was 8% vs. 8% (p = 1) in the Ccr-L and Ccr-H groups, respectively. No other hematological or nonhematological toxicities differed between patients in the two groups. No grade 4 or 5 toxicities were observed in the two groups. No significant difference was observed in the treatment completion rates (88% vs. 92%, p = 1) between patients in the Ccr-L and Ccr-H groups. CONCLUSIONS Regardless of baseline renal function, DOC-RT is a safe regimen for elderly patients with EC.
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Affiliation(s)
- Terufumi Kawamoto
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Naoto Shikama
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masahiko Tsurumaru
- Department of Esophageal and Gastroenterological Surgery, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Luo H, Jiang W, Ma L, Chen P, Fang M, Ding L, Hua Y, Du D, Jing Z, Xie R, Song Y, Wang J, Zhou R, Tian Z, Wu S. Icotinib With Concurrent Radiotherapy vs Radiotherapy Alone in Older Adults With Unresectable Esophageal Squamous Cell Carcinoma: A Phase II Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2019440. [PMID: 33026449 PMCID: PMC7542309 DOI: 10.1001/jamanetworkopen.2020.19440] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Importance Palliative radiotherapy (RT) is generally recommended for older patients with esophageal squamous cell carcinoma (ESCC) with poor prognosis. A new combination treatment is therefore needed. Objective To assess the efficacy and toxicity of RT plus icotinib vs RT alone in older patients with ESCC. Design, Setting, and Participants This randomized, multicenter, open-label, phase II clinical trial was conducted in China, with enrollment between January 1, 2015, and October 31, 2016. Patients aged 70 years or older with clinical stage T2 to T4, N0/1, M0/1a unresectable (because of comorbidities, T4 disease, unresectable lymph node, or refused surgery) ESCC were randomized 1:1 to receive RT plus icotinib or RT alone. Radiation was prescribed at 60 Gy in 30 fractions in both groups, and icotinib was administered at a dosage of 125 mg 3 times a day in the RT plus icotinib group. The last follow-up was completed on June 30, 2019, and data were analyzed from July 1 to September 30, 2019. Interventions Patients were randomized to either RT plus icotinib or RT alone. Main Outcomes and Measures The primary end point was overall survival (OS). Treatment-related toxic effects were evaluated. Immunohistochemistry was performed to analyze epidermal growth factor receptor (EGFR) expression if available. Results A total of 127 patients (median age, 76 years [range, 70-91 years]; 76 men [59.8%]) were enrolled and were eligible for survival analysis. Median OS was 24.0 (95% CI, 22.2-25.8) months in the RT plus icotinib group vs 16.3 (95% CI, 13.8-18.8) months in the RT group (hazard ratio, 0.53; 95% CI, 0.33-0.87; P = .008). No difference was observed in grades 3 or 4 adverse events. Patients with EGFR overexpression had a significantly better median overall survival (not reached vs 16.3 months [range, 2.6-45.1 months]; P = .03) in the RT plus icotinib group. Conclusions and Relevance In this randomized clinical trial, icotinib plus RT was well tolerated and improved OS in older patients with ESCC relative to RT alone. Patients with EGFR overexpression benefitted more from icotinib with RT. Trial Registration ClinicalTrials.gov Identifier: NCT02375581.
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Affiliation(s)
- Honglei Luo
- Department of Radiation Oncology, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Wei Jiang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Li Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Peng Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Min Fang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Lingyu Ding
- Department of Medical Oncology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Yuhui Hua
- Department of Pharmacy, Hangzhou Cancer Hospital, Hangzhou, China
| | - Dexi Du
- Department of Radiation Oncology, Lishui Central Hospital, Lishui, China
| | - Zhao Jing
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Ruifei Xie
- Department of Bio-informatics, Hangzhou Cancer Hospital, Hangzhou, China
| | - Yaqi Song
- Department of Radiation Oncology, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Jiayang Wang
- Department of Radiation Oncology, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Rongjing Zhou
- Department of Pathology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Zhifeng Tian
- Department of Radiation Oncology, Lishui Central Hospital, Lishui, China
| | - Shixiu Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
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It's not always too late: a case for minimally invasive salvage esophagectomy. Surg Endosc 2020; 35:4700-4711. [PMID: 32940794 DOI: 10.1007/s00464-020-07937-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/25/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Standard of care for locally advanced esophageal carcinoma is neoadjuvant chemoradiation (nCRT) and surgical resection 4-8 weeks after completion of nCRT. It is recommended that the CRT to surgery interval not exceed 90 days. Many patients do not undergo surgery within this timeframe due to patient/physician preference, complete clinical response, or poor performance status. Select patients are offered salvage esophagectomy (SE), defined in two ways: resection for recurrent/persistent disease after complete response to definitive CRT (dCRT) or esophagectomy performed > 90 days after completion of nCRT. Salvage esophagectomy reportedly has higher postoperative morbidity and poor survival outcomes. In this study, we assessed outcomes, overall, and disease-free survival of patients undergoing salvage esophagectomy by both definitions (recurrent/persistent disease after dCRT and/or > 90 days), compared to planned (resection after nCRT/within 90 days) esophagectomy (PE). MATERIALS AND METHODS Retrospective review of a prospectively maintained database identified patients who underwent minimally invasive esophagectomy at a single institution from 2009 to 2019. Esophagectomy for benign disease and patients who did not receive nCRT were excluded. Outcomes included postoperative complications, length of stay (LOS), disease-free survival, and overall survival. RESULTS 97 patients underwent minimally invasive esophageal resection for esophageal carcinoma. 89.7% of patients were male. Mean age was 64.9 years (range 36-85 years). 94.8% of patients had adenocarcinoma, with 16 transthoracic and 81 transhiatal approaches. On comparing planned esophagectomy (n = 87) to esophagectomy after dCRT failure (n = 10), no significant differences were identified in overall survival (p = 0.73), disease-free survival (p = 0.32), 30-day or major complication rate, anastomotic leak, or LOS. Similarly, when comparing esophagectomy < 90 days after CRT (n = 62) to > 90 days after CRT completion (n = 35), no significant differences were identified in overall survival (p = 0.39), disease-free survival (p = 0.71), 30-day or major complication rate, LOS, or anastomotic leak rate between groups. In this comparison, local recurrence was noted to be elevated with SE as compared to PE (64.3% vs. 25.0%, p = 0.04). CONCLUSION Overall survival and disease-free survival were equivalent between SE and PE. Local recurrence was noted to be increased with SE, though this did not appear to affect survival. Although planned esophagectomy remains the standard of care, salvage esophagectomy has comparable outcomes and is appropriate for selected patients.
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Zhi X, Jiang K, Shen Y, Su X, Wang K, Ma Y, Zhou L. Peripheral blood cell count ratios are predictive biomarkers of clinical response and prognosis for non-surgical esophageal squamous cell carcinoma patients treated with radiotherapy. J Clin Lab Anal 2020; 34:e23468. [PMID: 32681567 PMCID: PMC7595892 DOI: 10.1002/jcla.23468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 05/25/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
Background Peripheral blood cell count ratios, including the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and lymphocyte‐to‐monocyte ratio (LMR), have been reported to be prognostic factors in many malignancies as markers of inflammation and immune status. The aim of this study was to determine whether NLR, PLR, or LMR can be clinical response and prognostic biomarkers of non‐surgical esophageal squamous cell carcinoma (ESCC) patients treated with radiotherapy. Methods 193 non‐surgical ESCC patients who underwent radiotherapy were retrospectively analyzed. The peripheral blood cell count ratios were obtained before, during (weekly) and at the end of the treatment. Then, we compared the subsequent results with the corresponding pretreatment values and computed the rates of change, which were defined as cNLR, cPLR, and cLMR. Univariate and multivariate Cox regression analyses were used for overall survival (OS). Ordinal logistic regression was used to analyze the clinical response. Results In multivariate analysis, cNLR at week 4(P = .026) and week 5(P = .025) during radiotherapy were significantly associated with OS, along with BMI, tumor stage, tumor length, tumor location, and grade of adverse events. Besides, BMI, tumor stage, tumor length, adverse event grade, cNLR at week 4(P = .044) and week 5(P = .013), and cPLR at week 4(P = .034) and week 5(P = .015) were significantly associated with the clinical response in the multivariate logistic regression analysis. Conclusions The cNLR at weeks 4 and 5 was negatively correlated with the OS and clinical response of non‐surgical ESCC patients treated with radiotherapy. The elevated cPLR at weeks 4 and 5 was only related to poor clinical response.
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Affiliation(s)
- Xiaohui Zhi
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
| | - Kan Jiang
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
| | - Yue Shen
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China.,Shandong Provincial Key Laboratory of Radiation Oncology, Cancer Research Center, Shandong Academy of Medical Sciences, Shandong Cancer Hospital affiliated to Shandong University, Jinan, China
| | - Xinyu Su
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
| | - Ke Wang
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
| | - Yuanyuan Ma
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
| | - Liqing Zhou
- Department of Radiation Oncology, the Affiliated Huai'an Hospital of Xuzhou Medical University, the Second People's Hospital of Huai'an, Huai'an, China
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Duan Z, Cai G, Li J, Chen X. Cisplatin-induced renal toxicity in elderly people. Ther Adv Med Oncol 2020; 12:1758835920923430. [PMID: 32489432 PMCID: PMC7238313 DOI: 10.1177/1758835920923430] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 03/20/2020] [Indexed: 01/19/2023] Open
Abstract
Despite available prevention and treatment measures, such as hydration, diuresis, magnesium supplementation, and amifostine, renal toxicity is still one of the major dose-limiting side effects of cisplatin. The aim of this review is to discuss the issue of cisplatin-induced nephrotoxicity in the elderly. Compared with young patients, the incidences of cisplatin-induced nephrotoxicity and acute kidney injury (AKI) in elderly patients are significantly increased, and survival time may be decreased. Following cisplatin treatment of elderly patients, tubulointerstitial injuries will be significantly aggravated based on their original age, both for acute injuries due to cell necrosis and exfoliation and chronic injuries due to interstitial fibrosis, tubular atrophy, and dilatation. The high incidence of cisplatin-induced nephrotoxicity in elderly patients may be associated with renal hypoperfusion; increased comorbidities, such as chronic kidney disease (CKD), cardiovascular disease, and diabetes mellitus; increased use of combined drugs [especially non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitor and angiotensin receptor blockers (ACEI/ARB), and antibiotics]; decreased clearance of cisplatin; and high plasma ultrafilterable cisplatin. Considering hemodynamic stability and water balance, short duration and low volume hydration may be more suitable for treating elderly people. With the increasing popularity of low-dose daily/weekly regimens, we do not recommend routine diuretic treatment for elderly patients. We recommend using a less nephrotoxic platinum if large doses of cisplatin (100mg/m2) are needed.
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Affiliation(s)
- ZhiYu Duan
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
| | - GuangYan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, 28 Fuxing Road, Beijing, 100853, China
| | - JiJun Li
- Department of Nephrology, The Fourth Medical Center of PLA General Hospital, Beijing, China
| | - XiangMei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China
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Kawamoto T, Shikama N, Oshima M, Kosugi Y, Tsurumaru M, Sasai K. Safety of radiotherapy with concurrent docetaxel in older patients with esophageal cancer. J Geriatr Oncol 2019; 11:675-679. [PMID: 31471169 DOI: 10.1016/j.jgo.2019.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Considering that therapeutic strategies for older adult patients with esophageal cancer (EC) remain controversial, we aimed to assess the safety of radiotherapy with concurrent docetaxel (DOC-RT) among older adult patients with EC. MATERIALS AND METHODS Eligible patients included those aged ≥76 years who were diagnosed with esophageal squamous cell carcinoma. Patients received radiotherapy (60 Gy in 30 fractions) and concurrent docetaxel (10 mg/m2 weekly for six cycles). Survival, toxicity, and treatment completion rates were retrospectively evaluated. RESULTS Among 84 older adult patients receiving radical radiotherapy or chemoradiotherapy, 73 receiving DOC-RT were studied. Median follow-up duration was 14 months (range, 2-101 months). The 1-, 3-, and 5-year overall survival rates were 63%, 33%, and 13%, respectively, with a median survival time of 21 months. Grade 3 acute toxicities included esophagitis (7%), esophageal fistula (3%), pneumonitis (1%), leukopenia (10%), and anemia (8%). Grade 3 late toxicities included esophageal stenosis (4%), pleural effusion (3%), pericardial effusion (1%), and pneumonitis (1%). Grade 4 and 5 toxicities were not observed. DOC-RT was discontinued due to deterioration in the general condition (6%), esophageal fistula (3%), pneumonia (1%), and pain (1%), resulting in a DOC-RT completion rate of 89% (65/73 patients). The non-completion group comprised a higher proportion of older adults (age ≥ 80 years) and undernourished [geriatric nutritional risk index (GNRI <92)] patients than the completion group. CONCLUSION DOC-RT can be a safe regimen for older adult patients with EC. Nonetheless, old age (≥80 years) and undernourishment (GNRI <92) should be considered prior to DOC-RT administration.
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Affiliation(s)
- Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Japan.
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Japan
| | - Yasuo Kosugi
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Japan
| | - Masahiko Tsurumaru
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Graduate School of Medicine, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Juntendo University, Graduate School of Medicine, Japan
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Abstract
Geriatric medicine is a growing field filled with complicated patients who are susceptible to developing cancer. Surgical oncology is expanding while adapting to the increasing elderly population and creating novel treatment regimens for this group of patients. This article reviews surgical oncology in elderly patients and addresses surgical optimization, management of several cancer subtypes, surgical advances in minimally invasive surgery, and ethical considerations.
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Iizuka T, Kikuchi D, Hoteya S. Outcomes of endoscopic submucosal dissection for superficial esophageal cancer in an elderly population: a retrospective single center cohort study. Endosc Int Open 2019; 7:E355-E360. [PMID: 30834294 PMCID: PMC6395099 DOI: 10.1055/a-0832-8257] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022] Open
Abstract
Background and study aims Endoscopic submucosal dissection (ESD) is increasingly being used to treat superficial esophageal cancer in the elderly. However, data on clinical outcomes in this age group are limited. The aim of this study was to evaluate the safety and efficacy of ESD in treatment of superficial esophageal cancer and its effect on long-term outcome in the elderly. Patients and methods In total, 664 consecutive patients with a histological diagnosis of squamous cell carcinoma or high-grade intraepithelial neoplasia who underwent ESD between April 2008 and March 2016 at our institution were enrolled. Clinical outcomes and prognostic factors were compared retrospectively between those aged 75 years or older (n = 162) and those aged younger than 75 years (n = 502). Results There was no significant difference in post-ESD bleeding (0 vs. 0.8 %, P = 0.27) and perforation rates (1.8 vs. 1.2 %, P = 0.47) between the two age groups; however, stricture rate was higher in younger patients than in elderly patients (20.8 % vs 11 %; P = 0.036). There was no significant difference in the rate of locoregional recurrence between the two groups. Overall survival was significantly different between the two groups, but cause-specific survival was similar. Conclusion These findings confirm the efficacy of ESD for superficial esophageal cancer in selected elderly patients (75 years or older) who were fit for the treatment because they can achieve similar long-term survival to younger patients.
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Affiliation(s)
- Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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Song T, Fang M, Wu S. Concurrent chemoradiation therapy tailored to the older adults with esophageal cancer: state of the art and the future. Clin Interv Aging 2018; 13:2275-2287. [PMID: 30519009 PMCID: PMC6233861 DOI: 10.2147/cia.s179014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose The aim of this study was to review the published literature addressing the question of whether geriatric assessment (GA) should be routinely applied in the treatment of older adults with esophageal cancer (EC) who have received definitive concurrent chemoradiotherapy (dCRT). Materials and methods A literature search of PubMed, Embase, and Cochrane Library was performed. Studies that contained original data outlining the inclusion and exclusion criteria, treatment compliance rate, and severe toxicity reports were reviewed. Additionally, criteria from ongoing clinical trials in the World Health Organization and National Institutes of Health registries were reviewed to evaluate the utilization of GA-related domains in elderly EC patients who received dCRT. Results Twenty-nine studies were identified based on the selection criteria: five were single-arm prospective studies, and the other studies were retrospective studies. All studies used chronological age and performance status as basic descriptors for this subpopulation. The comorbidity index and the malnutrition level were mentioned in several studies. However, factors such as “Demographic data and social support,” “Psychology,” “Polypharmacy,” and “Geriatric syndromes” were not described in any of the included studies. Unfortunately, the results were similar for the registered clinical trials. Finally, treatment compliance and toxicity profile were found to be acceptable in selected elderly EC patients. Conclusion The current experience for older adults with EC receiving dCRT is mainly based on the results of a series of retrospective studies. Ongoing clinical trials should routinely consider GA-related domains to select appropriate treatments for patients in the future.
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Affiliation(s)
- Tao Song
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang, People's Republic of China
| | - Min Fang
- Department of Radiation Oncology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310000, Zhejiang, People's Republic of China
| | - Shixiu Wu
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou 310000, Zhejiang, People's Republic of China,
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The role of definitive chemoradiation in patients with non-metastatic oesophageal cancer. Best Pract Res Clin Gastroenterol 2018; 36-37:53-59. [PMID: 30551857 DOI: 10.1016/j.bpg.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/19/2018] [Indexed: 01/31/2023]
Abstract
Definitive chemoradiation (dCRT) is a curative treatment option for patients with oesophageal cancer. It is effective in both adenocarcinoma and squamous cell carcinoma. However, locoregional control is less after dCRT compared to preoperative CRT (pCRT) followed by surgery. Also, overall survival is lower compared to pCRT followed by surgery, which can only partly be explained by a negative selection of patients. The optimal dose of radiotherapy remains to be determined, but dose escalation above 50.4Gy might be beneficial. Cisplatinum/5-FU is the most applied concurrent chemotherapy, but carboplatin/paclitaxel seems equally effective with less toxicity. The addition of 5-FU to a taxane and platinum seems promising. Accelerated fractionation and addition of cetuximab did not improve results. dCRT is a successful treatment for regional lymph node recurrences, but less so for recurrences at the anastomotic site. Re-irradiation after prior curative radiotherapy yields poor results. dCRT can be safely used in carefully selected elderly.
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Ogino I, Watanabe S, Hirasawa K, Misumi T, Hata M, Kunisaki C. The Importance of Concurrent Chemotherapy for T1 Esophageal Cancer: Role of FDG-PET/CT for Local Control. In Vivo 2018; 32:1269-1274. [PMID: 30150456 PMCID: PMC6199580 DOI: 10.21873/invivo.11376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 12/29/2022]
Abstract
AIM To evaluate whether patients with T1 esophageal squamous cell carcinoma receiving definitive radiotherapy can be managed without concurrent chemotherapy, and the role of 18F-fluorodeoxyglucose positron-emission tomography with computed tomography (FDG-PET/CT) in demonstrating local control (LC). PATIENTS AND METHODS Twenty-four out of 37 patients with newly-diagnosed T1 EC treated with definitive radiotherapy between July 2009 and July 2016 were retrospectively analyzed. FDG-PET/CT was performed before treatment. Eleven patients were assigned to a concurrent chemoradiotherapy (CRT) group. Thirteen were placed in a no-CRT group. The two groups were compared and univariate analysis of clinical factors influencing the prognosis in each group was conducted. RESULTS Mean radiotherapy doses were 59.2 Gy in the no-CRT group and 55.5 Gy in the CRT group (p=0.025). Overall survival, disease-free survival, and LC rates at 2 years were lower in the no-CRT group compared to the CRT group. Disease-free survival and LC rates at 2 years were significantly lower in the patients with FDG-avid primary tumor in the no-CRT group (p=0.002 and p=0.002, respectively). All patients with FDG-avid primary tumors in the no-CRT group developed local recurrence. CONCLUSION It is important to note that all patients with FDG-avid primary tumor in the no-CRT group developed local recurrence. This would suggest that concurrent chemotherapy is an integral part of disease management in patients with T1 esophageal squamous cell carcinoma.
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Affiliation(s)
- Ichiro Ogino
- Department of Radiation Oncology, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shigenobu Watanabe
- Department of Radiation Oncology, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshihoro Misumi
- Department of Biostatistics, Yokohama City University, Yokohama, Japan
| | - Masaharu Hata
- Division of Radiation Oncology, Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
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Duan ZY, Liu JQ, Yin P, Li JJ, Cai GY, Chen XM. Impact of aging on the risk of platinum-related renal toxicity: A systematic review and meta-analysis. Cancer Treat Rev 2018; 69:243-253. [PMID: 30121504 DOI: 10.1016/j.ctrv.2018.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Renal toxicity limits the clinical use of platinum-based therapy in the elderly. In order to clarify the impact of aging on the risk of platinum-related nephrotoxicity, the following meta-analysis was performed. METHODS We searched multiple databases for studies published before January 2017. The inclusion criteria were case-control, cohort studies published in any language. RESULTS The risk of platinum-induced nephrotoxicity in the older group was 1.43 times (risk rate) higher than in the non-older group. Platinum-induced nephrotoxicity in older patients was mainly I/II. There was no significant difference in the incidence of grade III/IV renal toxicity between groups. The risk for elderly patients in Asia was significantly higher than in Europe and North America. Carboplatin had a lower risk of renal toxicity and only half of the amount of moderate and severe nephrotoxicity than cisplatin. In the age stratification analysis, the RR values were 1.43, 1.51 and 1.35 respectively for the elderly group (55, 60, 70 years old), and all had significant differences. The risk of platinum-related nephrotoxicity in elderly patients was significantly increased in the high comorbidity rate group. Moreover, the RR values of the normal renal function group were significantly higher than that of the 'no mention or renal insufficiency' subgroup. CONCLUSIONS Aging increased the risk of platinum-induced nephrotoxicity by 43%, partly due to more comorbidities in elderly patients, and mild renal toxicity was dominant. The risk of renal toxicity of the elderly patients in Asian countries was much higher than that of in European countries and North America.
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Affiliation(s)
- Zhi-Yu Duan
- Department of Nephrology, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
| | - Jie-Qiong Liu
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Pei Yin
- Department of Nephrology, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China
| | - Ji-Jun Li
- Department of Nephrology, First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100048, China.
| | - Guang-Yan Cai
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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Watanabe A, Katada C, Komori S, Moriya H, Yamashita K, Harada H, Azuma M, Kondo Y, Kubota Y, Furue Y, Kawanishi N, Yamane S, Wada T, Yano T, Ishido K, Tanabe S, Hayakawa K, Koizumi W. Feasibility of definitive chemoradiation therapy with nedaplatin and 5-fluorouracil in elderly patients with esophageal squamous cell carcinoma: A retrospective study. Adv Radiat Oncol 2018; 3:305-313. [PMID: 30197939 PMCID: PMC6127966 DOI: 10.1016/j.adro.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/23/2018] [Accepted: 02/20/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study was designed to retrospectively analyze the safety and efficacy of chemoradiation therapy with nedaplatin and 5-fluorouracil in elderly patients with esophageal squamous cell carcinoma. METHODS AND MATERIALS Eligible patients were aged 76 years or older, had a histopathologic diagnosis of esophageal squamous cell carcinoma, and were treated at the Kitasato University Hospital between January 2010 and March 2016. Chemotherapy consisted of nedaplatin in an intravenous dose of 90 mg/m2 on day 1 and 5-fluorouracil in an intravenous dose of 800 mg/m2 on days 1 to 5, repeated every 4 weeks for 2 cycles. Radiation therapy consisted of 50.4 Gy in 28 fractions for thoracic tumors and 61.2 Gy for cervical tumors. RESULTS Twenty-five patients were studied. Patient characteristics were as follows: median age 79 years (range, 76-85 years), clinical stage I/II/III/IV (7/8/8/2, respectively), and surgically resectable/unresectable (17/8, respectively). The completion rates of radiation therapy and chemoradiation therapy were 100% and 84%, respectively. Grade ≥3 acute toxicities included neutropenia (76%), leukopenia (72%), thrombocytopenia (32%), anemia (28%), anorexia (32%), oral mucositis (20%), febrile neutropenia (12%), and esophagitis (8%). Grade ≥3 late toxicities included esophageal stenosis (12%) and pleural effusion (4%). The complete response rate was 64%. In the median follow-up period of 18.9 months, the 1-year overall survival rate was 68%. CONCLUSIONS Definitive chemoradiation therapy with nedaplatin and 5-fluorouracil may be a feasible treatment option for elderly patients with esophageal squamous cell carcinoma.
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Affiliation(s)
- Akinori Watanabe
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shouko Komori
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiromitsu Moriya
- Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keishi Yamashita
- Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hiroki Harada
- Department of Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mizutomo Azuma
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuki Kondo
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yo Kubota
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasuaki Furue
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Natsuko Kawanishi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Sakiko Yamane
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takafumi Yano
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kenji Ishido
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Satoshi Tanabe
- Research and Development Center for New Frontier, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kazushige Hayakawa
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Wasaburo Koizumi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
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Walter F, Böckle D, Schmidt-Hegemann NS, Köpple R, Gerum S, Boeck S, Angele M, Belka C, Roeder F. Clinical outcome of elderly patients (≥ 70 years) with esophageal cancer undergoing definitive or neoadjuvant radio(chemo)therapy: a retrospective single center analysis. Radiat Oncol 2018; 13:93. [PMID: 29769143 PMCID: PMC5956563 DOI: 10.1186/s13014-018-1044-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/02/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To analyse the outcome of elderly patients (≥70 years) with esophageal cancer treated with curative intent radio(chemo)therapy. METHODS Fifty five patients (median 75 years) receiving curative intent radio(chemo)therapy for esophageal cancer from 1999 to 2015 were retrospectively analyzed. Most patients showed locally advanced disease (T3/4:78%, N+:58%) with squamous cell histology (74%). Charlson comorbidity score was > 1 in 27%. 48 patients (87%) received definitive treatment while 7 patients were treated neoadjuvantly. RT was carried out as 3D-conformal treatment or IMRT. Concurrent chemotherapy was applied in 85%, mainly cisplatin/5-FU or mitomycin/5-FU. 18FDG-PET/CT staging was used in 65%. RESULTS Median follow-up was 11 months (1-68) and 21 months in survivors. 1- and 2-year rates of LRC, DC, FFTF and OS were 60%/45, 81%/72, 55%/41 and 46%/26% for the entire cohort. In univariate analysis, addition of surgery was associated with improved LRC and FFTF, nodal involvement with improved DC and lower T stage, lower Charlson score and use of PET-CT with improved OS. In multivariate analysis, lower T stage and lower Charlson score remained significant for OS. Patients treated after 2008 showed a significantly improved FFTF (1-year FFTF 64% vs 35%) and OS (1-year OS 66% vs 24%). Maximum (chemo)radiation related grade3+ toxicity was observed in 80% including 7 deaths (13%). Grade5 toxicity was significantly associated with Charlson score (CS > 1:33% vs CS ≤ 1:5%) and treatment period (24% before vs 3% after 2008). The patients treated after 2008 included significantly more SCCs, less T4 stages, had a higher percentage of PET-CT staging and were treated with smaller field lengths. Trends were also observed for lower Charlson scores and increased use of IMRT. CONCLUSION Curative intent (chemo)radiation of elderly patients with esophageal cancer may result in considerable toxicity and unfavorable outcome. However, a clear improvement over time was observed in our cohort, probably based on improved patient selection. In patients with less advanced stages and lower comorbidity similar results as in younger cohorts seem achievable with modern staging and treatment approaches. Age per se should not be a decisive factor, but careful attention should be paid regarding patient selection including a structured and tight follow-up strategy.
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Affiliation(s)
- Franziska Walter
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany.
| | - David Böckle
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | | | - Rebecca Köpple
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Sabine Gerum
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Stefan Boeck
- Department of Internal Medicine III, University Hospital LMU Munich, Marchioninistr, 15, 81377, Munich, Germany
| | - Martin Angele
- Department of Surgery, University Hospital LMU Munich, Marchioninistr, 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Falk Roeder
- Department of Radiation Oncology, University Hospital LMU Munich, Marchioninistr 15, 81377, Munich, Germany.,Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Hamamoto Y, Sakakibara N, Nagashima F, Kitagawa Y, Higashi T. Treatment selection for esophageal cancer: evaluation from a nationwide database. Esophagus 2018; 15:109-114. [PMID: 29892936 DOI: 10.1007/s10388-018-0605-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/28/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Most elderly patients poorly tolerate the standard treatment for esophageal cancer; however, little information is available regarding the appropriateness of non-standard esophageal cancer treatments for those patients. This study aims to analyze the treatment costs and completion rates of patients undergoing a real-world treatment for esophageal cancer to elucidate the treatment selection and its quality. MATERIALS AND METHODS We analyzed treatment costs and completion rates for patients with esophageal cancer and analyzed these data relative to patient age and center volumes. Patients with esophageal cancer [UICC, TMN, Clinical stage II/III (excluding T4)] who were diagnosed in 2013 were analyzed. Patients were classified into five groups defined as follows: surgical therapy, chemotherapy, concurrent chemoradiotherapy (CCRT), modified concurrent chemoradiotherapy (mCRT), and radiotherapy (RT). RESULTS Mean and median age of patients who received surgery and CCRT were comparable; however, patients who underwent mCRT and RT tended to be older. Medical costs associated with surgery were higher than costs associated with other non-surgical treatments. Cost and completion rate of chemoradiotherapy did not differ between CCRT and mCRT; however, both had higher completion rates compared to that of RT. Surgical expenses tended to be the highest in low-volume centers and the lowest in high-volume centers. CONCLUSION Treatment of esophageal cancer at high-volume centers seems well balanced compared with medium- to low-volume centers. mCRT was widely performed and comparable in medical cost to CCRT, although additional clinical impacts were unclear.
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Affiliation(s)
- Yasuo Hamamoto
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan. .,Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan.
| | - Naoki Sakakibara
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan
| | - Fumio Nagashima
- Department of Medical Oncology, Kyorin University School of Medicine, Mitaka-shi, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji Chuoh-ku, Tokyo, 104-0045, Japan
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Wang W, Xing D, Song Y, Liu F. Effects of S-1 combined with radiotherapy in the treatment of advanced esophageal cancer: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2018; 97:e0164. [PMID: 29561425 PMCID: PMC5895356 DOI: 10.1097/md.0000000000010164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Esophageal cancer is one of the worst malignant digestive neoplasms with poor treatment outcomes. Definitive concurrent chemoradiotherapy (CRT) has become the standard nonsurgical treatment option for locally advanced esophageal cancer. The chemotherapeutic drugs 5-fluorouracil and cisplatin have been most commonly used in CRT of esophageal cancer. However, radiotherapy combined with 5-FU/cisplatin often delivers severe toxicity to patients. S-1 as an oral chemotherapeutic drug exhibits higher anti-tumor activity, less adverse effects, and better biological availability. S-1 also has excellent effects as a CRT regimen for esophageal cancer. METHODS A systematic literature search will be performed through January 2018 using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar for relevant articles published in any language. Randomized controlled trials, prospective comparative studies will be included. All meta-analyses will be performed using Review Manager software. The quality of the studies will be evaluated using the guidelines listed in the Cochrane Handbook. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements will be followed until the findings of the systematic review and meta-analysis are reported. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION Our study will draw an objective conclusion of the effects of S-1 combined with radiotherapy in the treatment of unresectable esophageal cancer and provide level I evidence for clinical decision makings.
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Affiliation(s)
- Wei Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Yingjian Song
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Feiyu Liu
- Department of Pharmacy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Deng W, Lin SH. Advances in radiotherapy for esophageal cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:79. [PMID: 29666802 DOI: 10.21037/atm.2017.11.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Esophageal cancer is a common type of malignancy worldwide and usually requires multidisciplinary care. Radiotherapy plays an important part in management of the disease. During the past few years, researchers have made much progress about radiotherapy for esophageal cancer, which was revealed in every aspect of clinical practice. Neoadjuvant chemoradiotherapy remains the standard treatment for locally advanced esophageal cancer, whereas neoadjuvant chemotherapy appears to show less toxicities and non-inferior prognosis. What's more, definitive chemoradiotherapy could be an option for non-surgical candidates and good responders to chemoradiotherapy. Advances in radiation techniques result in higher conformity, homogeneity, more normal tissue sparing and less treatment time. Promising prognoses and less toxicities were also seen in advanced techniques. As radiation dose higher than 50 Gy obtains better local control and survival, simultaneously integrated boost is designed to increase primary tumor dosage and keep prophylactic dose to subclinical areas. Elective nodal irradiation brings about better local control but do not show advantages in survival compared with involved field irradiation (IFI). As a trend, more tolerable chemoradiotherapy regimen would be taken into account in dealing with elderly patients.
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Affiliation(s)
- Wei Deng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Go SI, Lee WS, Kang MH, Song HN, Kim MJ, Lee MJ, Kim HG, Lee GW, Kang JH, Lee JH, Kang KM, Jeon KN, Cho JM, Jung WT, Ko GH. Response to Concurrent Chemoradiotherapy as a Prognostic Marker in Elderly Patients with Locally Advanced Esophageal Cancer. TUMORI JOURNAL 2018; 98:225-32. [DOI: 10.1177/030089161209800208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Little is known about chemoradiotherapy in elderly patients with locally advanced esophageal cancer. We compared the efficacy and toxicity of chemoradiotherapy in elderly and non-elderly patients with locally advanced esophageal cancer and determined the variables affecting the treatment outcome in the elderly patients with locally advanced esophageal cancer who had received chemoradiotherapy. Methods Fifty-seven elderly patients (age ≥65 years) and 30 non-elderly patients (age <65 years) were reviewed retrospectively. Results The median age of the elderly group was 69 years and in the non-elderly group, 56.5 years. Although treatment compliance appeared to be poor, the response rate and median survival were similar in both the groups (elderly versus non-elderly; 84.4% vs 87.5%, and 11.2 months vs11.3 months) and so were G3/4 hematologic and non-hematologic toxicities. The treatment-related mortality of the elderly patients appeared to be higher than that of the non-elderly group (7.0% vs 3.3%), but did not reach statistical significance. In prognostic factor analysis, a major response to chemoradiotherapy was a good prognostic indicator in the elderly group (response versus non-response; median overall survival times of 19.5 vs 5.4 months, respectively, P <0.001). Conclusions The study suggests that chemoradiotherapy for locally advanced esophageal cancer in elderly patients, even though treatment compliance appears to be poor, is as safe and effective as in non-elderly patients and that the response to chemoradiotherapy is related to prognosis in elderly patients.
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Affiliation(s)
- Se-Il Go
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Won Sup Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Myung Hee Kang
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Haa-Na Song
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Moon Jin Kim
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Jeong Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hoon-Gu Kim
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong-Hee Lee
- Department of Pathology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Mun Kang
- Department of Radiation Oncology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kyung-Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jae Min Cho
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Woon Tae Jung
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyung Hyuck Ko
- Department of Pathology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Ilson DH, van Hillegersberg R. Management of Patients With Adenocarcinoma or Squamous Cancer of the Esophagus. Gastroenterology 2018; 154:437-451. [PMID: 29037469 DOI: 10.1053/j.gastro.2017.09.048] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 02/07/2023]
Abstract
Esophageal cancer is characterized by early and frequent metastasis. Surgery is the primary treatment for early-stage disease, whereas patients with patients with locally advanced disease receive perioperative chemotherapy or chemoradiotherapy. Squamous cancers can be treated with primary chemoradiotherapy without surgery, depending on their response to therapy and patient tolerance for subsequent surgery. Chemotherapy with a fluorinated pyrimidine and a platinum agent, followed by later treatment with taxanes and irinotecan, provides some benefit. Agents that inhibit the erb-b2 receptor tyrosine kinase 2 (ERBB2 or HER2), or vascular endothelial growth factor, including trastuzumab, ramucirumab, and apatinib, increase response and survival times. Esophageal adenocarcinomas have mutations in tumor protein p53 and mutations that activate receptor-associated tyrosine kinase, vascular endothelial growth factor, and cell cycle pathways, whereas esophageal squamous tumors have a distinct set of mutations. Esophageal cancers develop systems to evade anti-tumor immune responses, but studies are needed to determine how immune checkpoint modification contributes to esophageal tumor development.
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Affiliation(s)
- David H Ilson
- Memorial Sloan Kettering Cancer Center, New York, New York.
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Wen Y, Zhao Z, Miao J, Yang Q, Gui Y, Sun M, Tian H, Jia Q, Liao D, Yang C, Du X. S-1 versus S-1 plus cisplatin concurrent intensity modulated radiation therapy in the treatment of esophageal squamous cell carcinoma: Study protocol for a randomized controlled phase II trial. Medicine (Baltimore) 2017; 96:e8998. [PMID: 29245275 PMCID: PMC5728890 DOI: 10.1097/md.0000000000008998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Chemotherapy regimens are often a 2-drug regimen in concurrent chemotherapy and radiotherapy for esophageal cancer (EC). However, some retrospective studies have suggested that for patients with EC receiving radiotherapy combined with 2-drug chemotherapy have the severe toxicity. And S-1 alone with the combination of radiotherapy treatment effect is good, and achieved good clinical remission rate. The purpose of this trial is compare the efficacy and toxicity of combining S-1 or S-1 plus cisplatin with radiotherapy for esophageal squamous cell carcinoma. METHODS/DESIGN The study is a randomized, controlled, multicenter trial, comparing S-1 versus S-1 plus cisplatin concurrent radiotherapy for patients with esophageal squamous cell carcinoma. Eighty-eight patients with unresectable or medically unfit for surgery esophageal squamous cell carcinoma (clinical stage I to III), will randomly assigned to receive four cycles (2 concomitant and 2 postradiotherapy) S-1 or S-1 plus cisplatin along with radiotherapy 60-66 Gy/30 to 33 fractions. The primary outcome is complete response rate of primary tumor which will be measured by endoscopy and computer screen at 3 months after the completion of treatment. Secondary outcomes include survival and toxicity. DISCUSSION To our knowledge, this study protocol is the first to test the effect between S-1 versus S-1 plus cisplatin concurrent intensity modulated radiation therapy in the treatment of esophageal squamous cell carcinoma. If the result will be the same effect and fewer side effects and less costly in S-1 plus radiotherapy. It will supply more treatment selection for esophageal squamous cell carcinoma.
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Affiliation(s)
- Yixue Wen
- Department of Oncology, Mianyang Central Hospital, Mian Yang
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nan Chong
| | - Zhenhuan Zhao
- Department of Oncology, Mianyang Central Hospital, Mian Yang
| | - Jidong Miao
- Department of Oncology, Zigong Fourth People's Hospital, Zi Gong
| | - Qilin Yang
- Department of Oncology, Ziyang People's Hospital, Zi Yang
| | - Yan Gui
- Department of Oncology, Guangyuan First People's Hospital, Guang Yuan
| | - Mingqiang Sun
- Department of Oncology, Guangyuan First People's Hospital, Guang Yuan
| | | | - Qiang Jia
- Department of Oncology, Jiangyou Second People's Hospital, Jiang You
| | - Dongbiao Liao
- Department of Oncology, Mianyang Central Hospital, Mian Yang
| | - Chen Yang
- Department of Oncology, Jianyang People's Hospital, Jian Yang, Sichuan, People's Republic of China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mian Yang
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Chen F, Luo H, Xing L, Liang N, Xie J, Zhang J. Feasibility and efficiency of concurrent chemoradiotherapy with capecitabine and cisplatin versus radiotherapy alone for elderly patients with locally advanced esophageal squamous cell carcinoma: Experience of two centers. Thorac Cancer 2017; 9:59-65. [PMID: 29024498 PMCID: PMC5754287 DOI: 10.1111/1759-7714.12536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 12/27/2022] Open
Abstract
Background The purpose of this retrospective study was to evaluate the feasibility and efficacy of definitive concurrent chemoradiotherapy (CCRT) with capecitabine and cisplatin for elderly patients with locally advanced esophageal squamous cell carcinoma. Methods A total of 90 patients were included from two different centers. Forty‐nine patients were treated with CCRT consisting of capecitabine (850 mg/m2, oral, twice a day for 1–14 days) and cisplatin (20 mg/m2) weekly during radiotherapy (RT). The remaining 41 patients were treated with RT alone. The overall response, overall survival, progression‐free survival, and toxicity rates were recorded. Results Compared to the RT group (51.2%; P = 0.029), the overall response rate in the CCRT group (73.5%) was obviously higher. A complete response was achieved in 34.7% and 14.6% of patients in the CCRT and RT groups, respectively (P = 0.030). Median progression‐free and median overall survival rates were significantly higher in the CCRT group (24.7 and 30.6 months; P < 0.05) compared to the RT group (16.6 and 18.7 months). Acute toxic effects were more severe in the CCRT group, but no significant difference in grade 3 or 4 acute toxicities was observed between the groups. Conclusion Both CCRT with capecitabine and cisplatin and RT alone are feasible to treat elderly patients and yield a good performance status with locally advanced esophageal squamous cell carcinoma. CCRT improved the tumor response without increasing the side effects compared to RT alone. CCRT is recommended for patients over 65 with good performance status.
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Affiliation(s)
- Fangjie Chen
- Department of Oncology, Weifang Medical College, Weifang, China
| | - Hui Luo
- Department of Radiation Oncology, Henan Cancer Hospital, Zhengzhou, China
| | - Ligang Xing
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China
| | - Ning Liang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Jian Xie
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Jiandong Zhang
- Department of Radiation Oncology, Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
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Zhao L, Zhou Y, Pan H, Yin Y, Chai G, Mu Y, Xiao F, Lin SH, Shi M. Radiotherapy Alone or Concurrent Chemoradiation for Esophageal Squamous Cell Carcinoma in Elderly Patients. J Cancer 2017; 8:3242-3250. [PMID: 29158796 PMCID: PMC5665040 DOI: 10.7150/jca.20835] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/29/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose: The reported data of elderly ESCC are rather limited and there is a lack of information to guide treatment decisions for elderly patients with esophageal cancer. This study aims to identify the efficacy and factors for optimal treatment approaches for elderly esophageal squamous cell carcinoma (ESCC) treated with radiotherapy (RT) alone or concurrent chemoradiation (CCRT). Methods: This study included 184 I-III elderly ESCC patients aged ≥70 years treated by oral single agent CCRT (sCCRT) or double agents CCRT (dCCRT) or RT alone at a single institution in China. RT was delivered with Intensity Modulated Irradiation Therapy (IMRT) or Volumetric-Modulated Arc Therapy (VMAT). Sequential or simultaneous integrated boost (SIB) approach was applied for GTV dose escalation. Toxicities were evaluated by criteria of Radiation Therapy Oncology Group. Statistical analyses were performed on survival and failure patterns. Results: At a median follow-up time of 15.5 months, the 2- and 3-year estimated overall survival (OS) were 43.5% and 35.2%, respectively. T and N stage, GTV dose (cutoff value 56Gy), simultaneous integrated boost (SIB) technique and CCRT were significant predictors for the outcomes. sCCRT was significantly associated with higher OS, LRFS, and DFS when compared with RT alone and no difference was observed between sCCRT and dCCRT. 44% patients experienced treatment failure, among whom 65.4% developed local failure. 81.3% local failure occurred in GTV and 70.6% regional failures occurred out of radiation field. dCCRT was the only independent prediction factor for grade ≥ 2 neutropenia and gastrointestinal reactions compared with sCCRT and RT alone. No significant difference of toxicities was observed between sCCRT and RT alone. Conclusions: Our results demonstrated that CCRT in elderly patients had significant survival benefit compared to RT alone, especially using Single oral agent. sCCRT had less toxicities compared to dCCRT, and the toxicity was similar to RT alone. GTV dose ≥ 56 Gy and SIB technique were optimal approaches for radiotherapy.
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Affiliation(s)
- Lina Zhao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Yongchun Zhou
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Haitao Pan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030
| | - Yutian Yin
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Guangjin Chai
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Yunfeng Mu
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Feng Xiao
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 097, Houston, Texas 77030, USA
| | - Mei Shi
- Department of Radiation Oncology, Xijing Hospital, Fourth Military Medical University, No. 127 West Changle Road, Xi'an, 710032 China
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Ji Y, Du X, Tian Y, Sheng L, Cheng L, Chen Y, Qiu G, Zhou X, Bao W, Zhang D, Chen M. A phase II study of S-1 with concurrent radiotherapy in elderly patients with esophageal cancer. Oncotarget 2017; 8:83022-83029. [PMID: 29137320 PMCID: PMC5669946 DOI: 10.18632/oncotarget.20938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
Background Concurrent chemoradiotherapy (CCRT) using conventional platinum-based doublets are often associated with significant incidence of toxic effects in elderly patients with esophageal cancer. We previously reported a phase I trial of CCRT using S-1, an oral 5-fluorouracil derivative, which yielded well safe and active outcomes. Methods Patients with histologically confirmed esophageal cancer, who were age of 70 years or older with performance status (PS) score of 0-2 or age of 66 to 69 with PS score of 2, were eligible for this Phase II trial. Radiotherapy was delivered in 1.8 Gy per fraction to a total dose of 54 Gy. Concurrently, S-1 was administered at 70 mg/m2 on days 1–14 and 29–42. The primary end point was 2-year overall survival rate. Results Thirty patients were enrolled, and 28 patients completed the full course of radiotherapy. No grade 4 toxicity or treatment-related death occurred. The grade 3 toxicities included esophagitis (16.7%), leucopoenia (13.3%), neutropenia (10%), anaemia (3.3%), pneumonitis (3.3%) and fatigue (3.3%). The median progression-free survival time and median survival time was 19 and 24 months, respectively. The 2-year overall survival rate was 45.1%, which exceeded the predefined threshold of 2-year OS 35% and met the primary end point of the study. Conclusions The results suggest that CCRT using S-1 is effective with mild toxicity in elderly patients with esophageal cancer. A phase III trial is needed to further evaluate this regimen.
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Affiliation(s)
- Yongling Ji
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, 215000 Suzhou, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Xianghui Du
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ye Tian
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, 215000 Suzhou, China
| | - Liming Sheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Lei Cheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ying Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Guoqing Qiu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Xia Zhou
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Wuan Bao
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Danhong Zhang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
| | - Ming Chen
- Department of Radiotherapy and Oncology, The Second Affiliated Hospital of Soochow University, 215000 Suzhou, China.,Department of Radiation Oncology, Zhejiang Cancer Hospital, 310022 Hangzhou, China.,Zhejiang Key Laboratory of Radiation Oncology, Hangzhou 310022, China
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Zhao Q, Hu G, Xiao W, Chen Y, Shen M, Tang Q, Ning X. Comparison of definitive chemoradiotherapy and radiotherapy alone in patients older than 75 years with locally advanced esophageal carcinoma: A retrospective cohort study. Medicine (Baltimore) 2017; 96:e7920. [PMID: 28858114 PMCID: PMC5585508 DOI: 10.1097/md.0000000000007920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the efficacy and acute toxicity of definitive chemoradiotherapy (CRT) and radiotherapy (RT) alone as initial treatment in patients aged 75 years and older with locally advanced esophageal squamous cell carcinoma (ESCC) who are not eligible for surgery.Between February 2009 and February 2015, 122 patients older than 75 years with locally advanced ESCC were retrospectively reviewed, in whom 52 patients allocated to the CRT group were treated with at least 2 cycles of platinum and 5-fluorouracil, 70 patients allocated to the RT group were treated with RT alone, all patients were received a total radiation dose of 54-66 Gy, with 1.8 or 2-Gy/fraction. Response rate (RR), progression-free survival (PFS), overall survival (OS), and acute toxicities were compared between the 2 different treatment groups.In the CRT group, the median PFS and OS were 15.3 and 24.6 months, while 10.6 and 19.4 months in the RT group (P = .008 and P = .018). The 1-year survival rates of the 2 groups were 78.8% versus 64.3% (P = .081), and the 2-year survival rates were 48.1% and 30.0% (P = .042), respectively. The objective RR was 55.8% in the CRT group with 18 complete response (CR) and 18.6% in the RT group with 13 CR. Acute toxicity in the CRT group was higher than in the RT group, especially the grade 3 to 4 acute toxicities.Compared with RT alone, definitive CRT in the treatment of locally advanced ESCC can prolong the survival time in elderly patients. Definitive CRT should be considered the first-treatment choice for elderly patients like the younger patients who are not eligible for surgery.
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Affiliation(s)
- Qian Zhao
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Guofang Hu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong province
| | - Wei Xiao
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Yan Chen
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province, China
| | - Meng Shen
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Qiang Tang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
| | - Xu Ning
- The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou province
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Münch S, Heinrich C, Habermehl D, Oechsner M, Combs SE, Duma MN. Primary radio(chemo)therapy for esophageal cancer in elderly patients: are efficiency and toxicity comparable with younger patients? Eur J Med Res 2017; 22:24. [PMID: 28683820 PMCID: PMC5501408 DOI: 10.1186/s40001-017-0265-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/26/2017] [Indexed: 12/12/2022] Open
Abstract
Purpose In elderly patients with esophageal cancer (EC), esophagectomy is associated with an increased mortality, and therefore these patients are often treated with definite (chemo)radiation. The purpose of this study was to assess the toxicity and efficiency of definite radio(chemo)therapy in patients >75 years compared with definite radio(chemo)therapy in patients <75 years. Methods 32 patients >75 years were treated with definite radio(chemo)therapy for EC. We compared baseline parameters, efficiency and toxicity rates of these patients to 39 patients <75 years. Results Patients <75 years were more likely to receive simultaneous chemotherapy, and had a lower age-adjusted Charlson comorbidity index (ACCI). 25% of elderly patients were treated in palliative intent. There was no significant difference in progression-free survival between patient groups. No significant differences were seen for overall survival (15.7 months vs. 19.9 months; p = 0.102) and progression-free survival (10.5 months vs. 9.2 months, p = 0.470) between older patients treated with curative intent and younger patients. In addition, there were no significant differences for dysphagia and hematological side effects between elderly patients and younger patients. Conclusion Definite (chemo)radiation is a feasible therapy for elderly patients. OS and PFS in elderly patients with a curative treatment approach are comparable to younger patients and it is not associated with higher toxicity rates.
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Affiliation(s)
- Stefan Münch
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Heinrich
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Practice for Radiotherapy, Norbert-Kerkel-Platz 1, 83734, Hausham, Germany
| | - Daniel Habermehl
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany
| | - Marciana-Nona Duma
- Department of Radiation Oncology, Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar/TU München, Ismaninger Str. 22, 81675, Munich, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Germany.
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Abstract
The objectives of this review were to assess both the short- and long-term clinical outcomes in patients managed with definitive chemoradiotherapy, and salvage esophagectomy subsequently in comparison to those neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS) for esophageal cancer from published literature. Eleven studies comprising 1,906 patients were included, 563 in the salvage group and 1,343 in the NCRS group. Pooled analysis showed no significant difference between salvage and NCRS groups in overall survival [hazard ratio (HR) =1.17; 95% confidence interval (95% CI), 0.94-1.46, P=0.148], postoperative mortality [pooled odds ratios (POR) =1.12; 95% CI, 0.52-2.41, P=0.775], pulmonary complications (POR =1.24; 95% CI, 0.83-1.86, P=0.292) and positive resection margin incidence (POR =1.29; 95% CI, 0.94-1.76, P=0.114). However, within the salvage group there were increases in postoperative morbidity (POR =1.30; 95% CI, 1.00-1.67, P=0.046) and anastomotic leak (POR =1.88; 95% CI, 1.41-2.51, P<0.001). Herein we found that salvage esophagectomy has similar short- and long-term mortality in comparison to planned esophagectomy following neoadjuvant chemoradiotherapy. However, anastomotic leak is increased following salvage esophagectomy suggesting the need for this practice to be reserved for high volume surgeons within high volume centers.
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Affiliation(s)
- Sara Jamel
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
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Won E. Issues in the Management of Esophagogastric Cancer in Geriatric Patients. Surg Oncol Clin N Am 2017; 26:335-346. [DOI: 10.1016/j.soc.2016.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Wang H, Li G, Chen L, Duan Y, Zou C, Hu C. Definitive concurrent chemoradiotherapy with S-1 and cisplatin in elderly esophageal squamous cell carcinoma patients. J Thorac Dis 2017; 9:646-654. [PMID: 28449472 DOI: 10.21037/jtd.2017.03.105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND To evaluate the feasibility and efficiency of definitive concurrent chemoradiotherapy (dCRT) with S-1 and cisplatin for elderly esophageal squamous cell carcinoma (ESCC) patients. METHODS Fifty-six elderly patients were included from January 2012 to December 2014. Patients received S-1 (tegafur/gimeracil/oteracil) and cisplatin at doses of 70 mg/m2/day for two weeks and 75 mg/m2 on day 1, respectively, every 3 weeks. Radiotherapy was delivered at a dose of 180-200 cGy per day to a total dose of 54 Gy. After dCRT, additional chemotherapy was administered for two cycles. RESULTS The median age was 74 years (range: 70-87 years) and 38 (67.9%) patients were staged with III-IVa. Totally, 38 patients completed dCRT as planned. An objective response rate (ORR) was seen in 47 (84.0%) patients. The median OS and PFS time were 18.2 and 13.9 months and the 3-year OS and PFS rates were 30.1% and 14.2%, respectively. The most frequent hematological toxicities were leucocytopenia and neutropenia with the incidence of 55.4% and 53.6%, respectively. A significantly higher incidence of severe leucocytopenia was observed between patients aged ≥75 and 70≤ age <75 years. The most common non-hematologic toxicity was esophagitis. CONCLUSIONS dCRT with S-1 and cisplatin yielded satisfactory survival outcomes but treatment-related toxicities were relatively high, especially for patients aged over 75 years.
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Affiliation(s)
- Hongqing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.,Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Gang Li
- Department of Radiotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yuxia Duan
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chunpeng Zou
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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49
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Takebayashi K, Tsubosa Y, Kamijo T, Iida Y, Imai A, Nagaoka M, Kitani T, Niihara M, Booka E, Shimada A, Nakagawa M, Onitsuka T. Comparison of Salvage Total Pharyngolaryngectomy and Cervical Esophagectomy Between Hypopharyngeal Cancer and Cervical Esophageal Cancer. Ann Surg Oncol 2016; 24:778-784. [PMID: 27714538 DOI: 10.1245/s10434-016-5474-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Total pharyngolaryngectomy and cervical esophagectomy (TPLCE) after chemoradiotherapy remains a challenge because of the high rate of complications and few available data on outcomes and safety. The purpose of this study was to evaluate the clinical significance of salvage TPLCE and to compare treatment outcomes between hypopharyngeal cancer and cervical esophageal cancer. METHODS Data from 37 consecutive patients who were diagnosed with potentially resectable hypopharyngeal and cervical esophageal cancer after chemoradiotherapy were retrospectively analyzed. The survival and surgical outcomes were investigated between the hypopharyngeal cancer and cervical esophageal cancer groups. RESULTS Twenty-six patients were included in hypopharyngeal cancer group and 11 patients were included in cervical esophageal cancer group. The baseline characteristics were balanced between the two groups. Compared to the hypopharyngeal cancer group, the cervical esophageal cancer group had significantly more frequent tracheal-related complications (p < 0.05) and stronger association of distal margin of the cervical esophagus and radiation field with tracheal ischemia after salvage surgery. CONCLUSIONS Salvage TPLCE can offer the exclusive chance of prolonged survival. Association of tracheal ischemia with salvage TPLCE was seen more frequently for cervical esophageal cancer. Therefore, the indication for salvage TPLCE must be carefully considered to maintain the balance between curability and safety.
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Affiliation(s)
- Katsushi Takebayashi
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan.,Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoyuki Kamijo
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
| | - Yoshiyuki Iida
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Atsushi Imai
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masato Nagaoka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Kitani
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Niihara
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Eisuke Booka
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ayako Shimada
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Nakagawa
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tetsuro Onitsuka
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
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50
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Ohba A, Kato K, Ito Y, Katada C, Ishiyama H, Yamamoto S, Ura T, Kodaira T, Kudo S, Tamaki Y. Chemoradiation therapy with docetaxel in elderly patients with stage II/III esophageal cancer: A phase 2 trial. Adv Radiat Oncol 2016; 1:230-236. [PMID: 28740892 PMCID: PMC5514160 DOI: 10.1016/j.adro.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/07/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The most effective treatments in elderly patients with esophageal cancer remain a subject of debate. This multicenter phase 2 study was designed to evaluate the efficacy and toxicity of chemoradiation therapy (CRT) with docetaxel (DTX) in elderly patients with stage II/III (non-T4) esophageal cancer. METHODS AND MATERIALS Patients ≥70 years of age with clinical stage II/III esophageal cancer received DTX at a weekly dose of 10 mg/m2 during 6 consecutive weeks and concurrent radiation therapy (60 Gy in 30 fractions). The primary endpoint was the 2-year survival rate, and the required number of enrolled patients was 37. RESULTS Between July 2008 and January 2011, 16 patients were enrolled. The study was prematurely closed because of slow accrual. Characteristics of the patients were as follows: median age, 77 years (range, 73-81); performance status 0/1, 4/12; and clinical stage IIA/IIB/III, 3/4/9. Of the 16 patients, 14 (87.5%) completed the CRT. The 2-year survival rate was 62.5% (90% confidence interval [CI], 42.5-82.5). The median survival time was 27.7 months (95% CI, 23.3-32.2 months) and the median progression-free survival was 15.2 months (95% CI, 5.4-25.0 months). Seven patients achieved complete response, resulting in a complete response rate of 43.8% (95% CI, 19.8-70.1). Grade 3 or higher acute toxicities included esophagitis (31.3%), anorexia (12.5%), leukopenia (6.3%), neutropenia (6.3%), thrombocytopenia (6.3%), mucositis (6.3%), and infection (6.3%). Grade 3 or higher late toxicities included esophagitis (12.5%), pleural effusion (12.5%), pneumonitis (6.3%), and pericardial effusion (6.3%). CONCLUSIONS CRT with DTX might be a treatment option for elderly patients with stage II/III esophageal cancer, particularly for patients who are medically unfit for surgery or cisplatin-containing therapy. However, further improvements of this therapy are required to decrease the incidence of esophagitis.
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Affiliation(s)
- Akihiro Ohba
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiromichi Ishiyama
- Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sachiko Yamamoto
- Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Ura
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takeshi Kodaira
- Department of Therapeutic Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Shigehiro Kudo
- Department of Radiation Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - Yoshio Tamaki
- Department of Radiation Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
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