Lisa Cooper1, Aaron R Dezube2, Luis E De León2, Suden Kucukak2, Emanuele Mazzola3, Clark Dumontier4, Harvey Mamon5, Peter Enzinger6, Michael T Jaklitsch2, Laura N Frain7, Jon O Wee2. 1. Division of Aging, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: lcooper5@bwh.harvard.edu. 2. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA. 3. Department of Data Science, Dana Farber Cancer Institute, Boston, MA, USA. 4. Division of Aging, Brigham and Women's Hospital, Boston, MA, USA; Marcus Institute of Aging Research, Boston, MA, USA. 5. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA. 6. Center for Esophageal and Gastric Cancer, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA. 7. Division of Aging, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
BACKGROUND: Chemoradiotherapy for Esophageal cancer followed by Surgery (CROSS regimen) is standard of care for locally-advanced esophageal cancer. We evaluated CROSS completion rates, toxicity, and postoperative outcomes between older and younger adults receiving trimodality therapy. METHODS: Retrospective analysis of patients with locally-advanced esophageal cancer who underwent CROSS regimen from May 2016 to January 2020 at a single academic center. Outcomes of those aged ≥70-years-old and <70 years-old were analyzed. RESULTS: Of 201 patients, 136 were <70 and 65 were ≥70 years. Older adults were more likely to be male (91% vs. 79%; p = 0.045), have higher ECOG scores (median 1 vs. 0; p = 0.003), Charlson-comorbidity index (median 6 vs. 4; p < 0.001), and undergo open procedures (20% vs. 8% p = 0.008). Most completed CROSS regimen (78% vs. 84% respectively) with similar rates of treatment discontinuation and dose reduction (all p > 0.05). Time to surgery following neoadjuvant therapy was similar between age groups, except in those ≥80-years-old as compared to <70-years-old (p < 0.05). Overall toxicity rates were similar (68% vs. 71% respectively; p = 0.676). Only rates of delirium (19% vs. 5%) and urinary retention (9% vs. 0%) were higher in older adults (both p < 0.05). Length of stay, discharge disposition, mortality, and overall survival were similar. Age was not an independent risk factor for complication, neoadjuvant toxicity or completion, surgery timing, nor worse overall or recurrence-free survival (p > 0.05). CONCLUSION: Trimodality CROSS regimen for esophageal cancer in older adults is feasible, with similar completion rates and postoperative outcomes as compared to their younger counterparts.
BACKGROUND: Chemoradiotherapy for Esophageal cancer followed by Surgery (CROSS regimen) is standard of care for locally-advanced esophageal cancer. We evaluated CROSS completion rates, toxicity, and postoperative outcomes between older and younger adults receiving trimodality therapy. METHODS: Retrospective analysis of patients with locally-advanced esophageal cancer who underwent CROSS regimen from May 2016 to January 2020 at a single academic center. Outcomes of those aged ≥70-years-old and <70 years-old were analyzed. RESULTS: Of 201 patients, 136 were <70 and 65 were ≥70 years. Older adults were more likely to be male (91% vs. 79%; p = 0.045), have higher ECOG scores (median 1 vs. 0; p = 0.003), Charlson-comorbidity index (median 6 vs. 4; p < 0.001), and undergo open procedures (20% vs. 8% p = 0.008). Most completed CROSS regimen (78% vs. 84% respectively) with similar rates of treatment discontinuation and dose reduction (all p > 0.05). Time to surgery following neoadjuvant therapy was similar between age groups, except in those ≥80-years-old as compared to <70-years-old (p < 0.05). Overall toxicity rates were similar (68% vs. 71% respectively; p = 0.676). Only rates of delirium (19% vs. 5%) and urinary retention (9% vs. 0%) were higher in older adults (both p < 0.05). Length of stay, discharge disposition, mortality, and overall survival were similar. Age was not an independent risk factor for complication, neoadjuvant toxicity or completion, surgery timing, nor worse overall or recurrence-free survival (p > 0.05). CONCLUSION: Trimodality CROSS regimen for esophageal cancer in older adults is feasible, with similar completion rates and postoperative outcomes as compared to their younger counterparts.
Authors: Rona Spector; Yifan Zheng; Beow Y Yeap; Jon O Wee; Abraham Lebenthal; Scott J Swanson; David E Marchosky; Peter C Enzinger; Harvey J Mamon; Antoon Lerut; Robert Odze; Amitabh Srivastava; Agoston T Agoston; Mingkhwan Tippayawang; Raphael Bueno Journal: Semin Thorac Cardiovasc Surg Date: 2015-06-20
Authors: David M Guttmann; Nandita Mitra; James M Metz; John Plastaras; Weiwei Feng; Samuel Swisher-McClure Journal: J Geriatr Oncol Date: 2017-09-06 Impact factor: 3.599
Authors: Jae Y Kim; Arlene M Correa; Ara A Vaporciyan; Jack A Roth; Reza J Mehran; Garrett L Walsh; David C Rice; Jaffer A Ajani; Dipen M Maru; Manoop S Bhutani; James Welsh; Edith M Marom; Stephen G Swisher; Wayne L Hofstetter Journal: Ann Thorac Surg Date: 2011-10-01 Impact factor: 4.330
Authors: R A Audisio; F Bozzetti; R Gennari; M T Jaklitsch; T Koperna; W E Longo; T Wiggers; A P Zbar Journal: Eur J Cancer Date: 2004-05 Impact factor: 9.162
Authors: Francisco Schlottmann; Paula D Strassle; Apoorve Nayyar; Fernando A M Herbella; Bruce A Cairns; Marco G Patti Journal: J Surg Res Date: 2018-04-16 Impact factor: 2.192
Authors: Gregory Vlacich; Pamela P Samson; Stephanie M Perkins; Michael C Roach; Parag J Parikh; Jeffrey D Bradley; A Craig Lockhart; Varun Puri; Bryan F Meyers; Benjamin Kozower; Cliff G Robinson Journal: Cancer Med Date: 2017-11-15 Impact factor: 4.452
Authors: Aaron R Dezube; Lisa Cooper; Emanuele Mazzola; Daniel P Dolan; Daniel N Lee; Suden Kucukak; Luis E De Leon; Clark Dumontier; Bayonle Ademola; Emily Polhemus; Raphael Bueno; Abby White; Scott J Swanson; Michael T Jaklitsch; Laura Frain; Jon O Wee Journal: J Gastrointest Surg Date: 2022-03-31 Impact factor: 3.267