Chemoradiation is a tolerable therapy for older adults with esophageal cancer

INTRODUCTION: Esophageal adenocarcinoma (EC) is increasing in incidence. Chemoradiation (CRT) is regarded as an acceptable alternative to surgery for the management of locally advanced EC. Ten-20% of EC patients are over the age of 75 years. There are limited data regarding efficacy and tolerability of CRT for the treatment of EC in the elderly.

PATIENTS AND METHODS: We retrospectively reviewed EC cases > or = 70 years of age treated with CRT at a single institution. Clinical data, regarding therapy administered and outcome, were obtained from records. Clinical prognostic variables were analyzed against survival in a univariate model using the log rank test and in a multivariate model using Cox proportional hazards analysis.

RESULTS: Thirty consecutive patient records were identified. Commonly used chemotherapy agents included 5-fluorouracil, cisplatin, paclitaxel and oxaliplatin. There was no significant correlation between age and survival. The dose of chemotherapy or radiation was unrelated to any of the toxicities (p-values > 0.16). The most common grade 3 or 4 toxicities were dehydration, hypotension, mucositis and pneumonitis. On multivariate analysis, adenocarcinoma histology (p = 0.0094) and higher radiation dose (p = 0.0158) were associated with improved survival. The median survival of the patients was 10 months.

CONCLUSION: CRT was tolerable for older patients with EC. Close monitoring for dehydration, nutritional compromise and pulmonary toxicity is required.