Astrid E Slagter1, Benjamin Tudela2, Romy M van Amelsfoort1, Karolina Sikorska3, Johanna W van Sandick4, Cornelis J H van de Velde5, Nicole C T van Grieken6, Pehr Lind7, Marianne Nordsmark8, Hein Putter9, Maarten C C M Hulshof10, Hanneke W M van Laarhoven11, Cecile Grootscholten12, Jeffrey P B M Braak5, Elma Meershoek-Klein Kranenbarg5, Edwin P M Jansen1, Annemieke Cats12, Marcel Verheij13. 1. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 2. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Universidad de Valparaíso, Valparaíso, Chile. 3. Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands. 4. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 5. Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands. 6. Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands. 7. Department of Oncology, Stockholm Söder Hospital, Stockholm, Sweden; Karolinska Institutet, Stockholm, Sweden. 8. Department of Medical Oncology, Aarhus University, Aarhus, Denmark. 9. Department of Biometrics, Leiden University Medical Center, Leiden, the Netherlands. 10. Department of Radiation Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. 11. Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands. 12. Department of Gastrointestinal Oncology/Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands. 13. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: Marcel.Verheij@radboudumc.nl.
Abstract
AIM: To evaluate treatment-related toxicity, treatment compliance, surgical complications and event-free survival (EFS) in older (≥70 years) versus younger (<70 years) adults who underwent perioperative treatment for gastric cancer. METHODS: In the CRITICS trial, 788 patients with resectable gastric cancer were randomised before start of any treatment and received preoperative chemotherapy (3 cycles of epirubicin, cisplatin or oxaliplatin and capecitabine), followed by surgery, followed by either postoperative chemotherapy or chemoradiotherapy (45Gy + cisplatin + capecitabine). RESULTS: 172 (22%) patients were older adults. During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger adults experienced severe toxicity (p < 0.001); older adults received significantly lower relative dose intensities (RDIs) for all chemotherapeutic drugs. Equal proportions of older versus younger adults underwent curative surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications and postoperative mortality. Postoperative therapy after curative surgery started in 87 (64%) older adults versus 391 (78%) younger adults (p < 0.001). Incidence of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults versus 113 (59%) in younger adults (p = 0.541); older adults received significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) for younger adults (p = 0.703), with comparable chemotherapy RDIs and radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger adults. CONCLUSION: Perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults compared with younger adults. As comparable proportions of patients underwent curative surgery, future studies should focus on neo-adjuvant treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00407186. EudraCT number: 2006-00413032.
RCT Entities:
AIM: To evaluate treatment-related toxicity, treatment compliance, surgical complications and event-free survival (EFS) in older (≥70 years) versus younger (<70 years) adults who underwent perioperative treatment for gastric cancer. METHODS: In the CRITICS trial, 788 patients with resectable gastric cancer were randomised before start of any treatment and received preoperative chemotherapy (3 cycles of epirubicin, cisplatin or oxaliplatin and capecitabine), followed by surgery, followed by either postoperative chemotherapy or chemoradiotherapy (45Gy + cisplatin + capecitabine). RESULTS: 172 (22%) patients were older adults. During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger adults experienced severe toxicity (p < 0.001); older adults received significantly lower relative dose intensities (RDIs) for all chemotherapeutic drugs. Equal proportions of older versus younger adults underwent curative surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications and postoperative mortality. Postoperative therapy after curative surgery started in 87 (64%) older adults versus 391 (78%) younger adults (p < 0.001). Incidence of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults versus 113 (59%) in younger adults (p = 0.541); older adults received significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) for younger adults (p = 0.703), with comparable chemotherapy RDIs and radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger adults. CONCLUSION: Perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults compared with younger adults. As comparable proportions of patients underwent curative surgery, future studies should focus on neo-adjuvant treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00407186. EudraCT number: 2006-00413032.
Authors: Astrid E Slagter; Marieke A Vollebergh; Edwin P M Jansen; Johanna W van Sandick; Annemieke Cats; Nicole C T van Grieken; Marcel Verheij Journal: Front Oncol Date: 2020-11-30 Impact factor: 6.244