Japanese Journal of Clinical Oncology Advance Access originally published online on April 23, 2009
Japanese Journal of Clinical Oncology 2009 39(6):360-366; doi:10.1093/jjco/hyp030
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© The Author (2009). Published by Oxford University Press. All rights reserved
Retrospective Review of Surgery and Definitive Chemoradiotherapy in Patients with Squamous Cell Carcinoma of the Thoracic Esophagus Aged 75 Years or Older
1 Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences,
2 Division of Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
For reprints and all correspondence: Shin-ichi Kosugi, Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan. E-mail: sugishin{at}med.niigata-u.ac.jp
Received October 22, 2008; accepted March 13, 2009
Objective: The aim of this study was to review the treatment outcomes of surgery and definitive chemoradiotherapy (CRT) in elderly patients with squamous cell carcinoma of the thoracic esophagus.
Methods: A total of 64 patients aged 75 or older were retrospectively reviewed; 40 were treated with surgery and 24 with CRT. The CRT group included eight patients with unresectable disease and four patients medically unfit for surgery. Surgery included esophagectomy with lymphadenectomy and CRT consisted of 60–70 Gy of radiation concurrent with 5-fluorouracil alone or combined with cisplatin. Short- and long-term outcomes and survival of each modality were assessed.
Results: In the surgery group, 33 patients (82.5%) had co-morbid conditions. Complete resection rate was 90.0%. An overall post-operative complication rate was 65.0% and in-hospital mortality was seen in three patients (7.5%). In the CRT group, complete response rate was 41.7%. Leukopenia was most common Grade 3 hematological toxicity. Treatment-related deaths caused by acute toxicities occurred in three patients (12.5%), whereas those caused by late toxicities in four (16.7%). For cStage I disease in the surgery group, the overall 1-, 3- and 5-year survival rate were 90.9%, 63.6% and 54.5%, respectively, with a median survival time of 78.7 months. For cStages II–IV, the median survival time of the surgery and the CRT group was 18.7 and 12.8 months, respectively.
Conclusions: The short- and long-term outcomes of surgery for the elderly seemed acceptable; however, definitive CRT may be a promising treatment modality. Further investigation may alter the sphere of influence in the field of esophageal cancer treatment in the elderly.
Key Words: aged 75 years or older • chemoradiotherapy • esophagectomy • retrospective study • squamous cell carcinoma of the thoracic esophagus