Outcome of Trimodal Therapy in Elderly Patients with Esophageal Cancer: Prognostic Value of the Charlson Comorbidity Index

Abstract

Background. In the real-world setting outside clinical trials, neoadjuvant chemoradiation therapy followed by esophagectomy may represent overtreatment in some elderly individuals with multiple comorbidities. Patients and Methods: Through an observational cohort study, consecutive patients with esophageal cancer treated with the protocol of the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) were compared to patients of similar age who underwent upfront surgery during the same study period. Results: Fifty consecutive patients treated between 2010 and 2017 were enrolled. Thirty-two (64%) were older than 65 years and three (9.4%) were octogenarians. Eleven patients dropped-out of the protocol. Sixty-four patients undergoing upfront surgery served as controls. Compared to those who dropped out, patients who completed the protocol were younger (p=0.002) and had a lower Charlson Comorbidity Index (CCI) (p=0.003); the CCI was also lower (p=0.006) in the group treated with upfront surgery. The American Society of Anesthesiologists score did not discriminate between those who dropped out and patients who completed the protocol (p=0.I78). Conclusion: Routine use of the CCI may help in the pretreatment risk stratification of elderly patients with esophageal carcinoma.