BACKGROUND: While cancer is a disease of the elderly, these patients are under-represented in randomized trials. Esophageal cancer-management in the elderly is challenging because of the morbidity and mortality associated with surgery. OBJECTIVES: We examined a strategy of neo-adjuvant chemo-radiotherapy (naCRT), followed by surgery or surveillance, in selected patients with cancer aged 70 and older. METHODS: A prospectively-accrued database identified 56 consecutive patients over a 90-month period, who were aged 70years and over, presented with esophageal carcinoma and were treated with neo-adjuvant CRT (naCRT)±surgery. RESULTS: Of 129 eligible patients, 66 (51%) received palliative measures, while 63 (49%) had curative intervention, namely 7 had surgery and 56 had naCRT±surgery. Of these 56 patients, 33 (59%) had adenocarcinoma (AC) and 23 (41%) had squamous cell carcinoma (SCC). Twenty-five (45%) had a complete clinical response (cCR), of which 6 had immediate resection; 4 (67%) had a complete pathological response (pCR); 19 patients with a cCR declined or were unfit for surgery and underwent surveillance; of these, 3 had interval esophagectomy; 16 were not offered or declined resection. Eight (50%) have survived ≥3years. Mean overall survival was 28months for the entire cohort; 47months for cCRs; 61months for patients undergoing primary resection, 46months for cCRs who did not undergo resection and 29months for those undergoing interval resection for recurrent disease. In cCRs, surgery did not provide a survival advantage (p=0.861). CONCLUSION: cCR yields an overall 3-year survival of 50% without operation. As 45% of patients have a cCR to naCRT, obligatory resection in high-risk cCR patients makes little sense. With the option for salvage esophagectomy in re-emergent disease, this selective strategy is an attractive alternative for elderly patients with cancer.
BACKGROUND: While cancer is a disease of the elderly, these patients are under-represented in randomized trials. Esophageal cancer-management in the elderly is challenging because of the morbidity and mortality associated with surgery. OBJECTIVES: We examined a strategy of neo-adjuvant chemo-radiotherapy (naCRT), followed by surgery or surveillance, in selected patients with cancer aged 70 and older. METHODS: A prospectively-accrued database identified 56 consecutive patients over a 90-month period, who were aged 70years and over, presented with esophageal carcinoma and were treated with neo-adjuvant CRT (naCRT)±surgery. RESULTS: Of 129 eligible patients, 66 (51%) received palliative measures, while 63 (49%) had curative intervention, namely 7 had surgery and 56 had naCRT±surgery. Of these 56 patients, 33 (59%) had adenocarcinoma (AC) and 23 (41%) had squamous cell carcinoma (SCC). Twenty-five (45%) had a complete clinical response (cCR), of which 6 had immediate resection; 4 (67%) had a complete pathological response (pCR); 19 patients with a cCR declined or were unfit for surgery and underwent surveillance; of these, 3 had interval esophagectomy; 16 were not offered or declined resection. Eight (50%) have survived ≥3years. Mean overall survival was 28months for the entire cohort; 47months for cCRs; 61months for patients undergoing primary resection, 46months for cCRs who did not undergo resection and 29months for those undergoing interval resection for recurrent disease. In cCRs, surgery did not provide a survival advantage (p=0.861). CONCLUSION: cCR yields an overall 3-year survival of 50% without operation. As 45% of patients have a cCR to naCRT, obligatory resection in high-risk cCR patients makes little sense. With the option for salvage esophagectomy in re-emergent disease, this selective strategy is an attractive alternative for elderly patients with cancer.
Authors: Abdelmonim E A Salih; Gary A Bass; Yvonne D'Cruz; Robert P Brennan; Sebastian Smolarek; Mayilone Arumugasamy; Thomas N Walsh Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584
Authors: Marlies S Reimers; Charla C Engels; Peter J K Kuppen; Cornelis J H van de Velde; Gerrit J Liefers Journal: Nat Rev Clin Oncol Date: 2014-06-24 Impact factor: 66.675
Authors: Sophie E Vollenbrock; Jolanda M van Dieren; Francine E M Voncken; Sietze T van Turenhout; Liudmila L Kodach; Koen J Hartemink; Johanna W van Sandick; Berthe M P Aleman; Regina G H Beets-Tan; Annemarieke Bartels-Rutten Journal: Eur Radiol Date: 2020-01-21 Impact factor: 5.315
Authors: Lisa Cooper; Aaron R Dezube; Luis E De León; Suden Kucukak; Emanuele Mazzola; Clark Dumontier; Harvey Mamon; Peter Enzinger; Michael T Jaklitsch; Laura N Frain; Jon O Wee Journal: Eur J Surg Oncol Date: 2021-04-17 Impact factor: 4.037
Authors: Bo Jan Noordman; Bas P L Wijnhoven; Sjoerd M Lagarde; Jurjen J Boonstra; Peter Paul L O Coene; Jan Willem T Dekker; Michael Doukas; Ate van der Gaast; Joos Heisterkamp; Ewout A Kouwenhoven; Grard A P Nieuwenhuijzen; Jean-Pierre E N Pierie; Camiel Rosman; Johanna W van Sandick; Maurice J C van der Sangen; Meindert N Sosef; Manon C W Spaander; Roelf Valkema; Edwin S van der Zaag; Ewout W Steyerberg; J Jan B van Lanschot Journal: BMC Cancer Date: 2018-02-06 Impact factor: 4.430