Outcomes in Patients 65 Years or Older Treated with Trimodality Therapy for Esophageal Carcinoma

Abstract

Purpose/Objective(s): There is little published information on the results of neoadjuvant chemoradiotherapy (CRT) followed by surgery in older patients due to the presumed increased risk for morbidity and mortality. We report our single institutional experience of trimodality therapy in patients with esophageal carcinoma 65 years of age or older. Materials/Methods: Patients treated with preoperative CRT followed by esophagectomy from 2002-2010 were identified for this IRB approved retrospective study. Patient and treatment characteristics, tolerance, response, and survival were analyzed in patients ≥ 65 years of age versus patients<65 years. The Pearson Chi-square test was used for categorical variables andWilcoxon Rank Sum test was used for continuous variables. Survival analysis was performed using the Proportional Hazards Model. Results: A total of 115 patients treated with trimodality therapy were identified; 30 patients were .65 years of age (26.1%), 19 patients were .70 years. Median follow up was 27.5 months (range 5.0- 93.8), and 93.3% of patients were treated to a median dose of 50.4 Gy with concurrent non-cisplatin/5-fluorouracil based concurrent chemotherapy. Between groups, there were no differences in gender, performance status, diabetes, cardiac history, pulmonary disease, smoking status, histology, radiation dose, days to completion of CRT, or days from completion of CRT to surgery. Overall peri-operative mortality was low, with no 30 day mortality and 3.5% 60 day mortality; both mortalities occurred in patients .70 years. The median length of post-operative hospital stay for patients.65 years was 15.5 days versus 11.0 days for patients<65 years (p = 0.003). There was no difference in complete pathologic response rate (pCR) between groups, but the rate of residual nodal disease at surgery was higher in patients .65 years compared to patients<65 years (53.3% versus 31.8%, p = 0.036). There was no difference in median overall survival between groups. For patients>65 years of age, median survival was 35.2 months and 3 and 5 year overall survival rates were 45.9% and 37.1% respectively. Conclusions: These data suggest that older patients can be appropriately selected for neoadjuvant chemoradiotherapy followed by surgery when a comprehensive multidisciplinary approach is utilized. Age alone should not preclude consideration for trimodality therapy in patients with esophageal carcinoma.