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Treatment improves OS in elderly patients with early-stage esophageal cancer
Elderly patients with early-stage esophageal cancer who received treatment achieved 5-year OS more often than those under observation, according to a retrospective study published in Journal of Thoracic Oncology.
“We have demonstrated that a surprisingly large proportion of patients aged 80 years or older with stage I esophageal cancer remain under clinical observation after their diagnosis,” Amy C. Moreno, MD, radiation oncologist at The University of Texas MD Anderson Cancer Center, and colleagues wrote. “Any form of local therapy, including chemoradiotherapy, statistically improved OS when compared with observation.”
The median age of patients diagnosed with esophageal cancer is about 67 years, and the rate of 5-year OS across all patients is 18.8%.
Although National Comprehensive Cancer Network guidelines suggest surgery as the standard treatment for stage I esophageal cancer, patients aged 80 years and older often are unable to undergo surgery due to multiple comorbidities or sociodemographic and socioeconomic challenges.
Researchers used the National Cancer Data Base to identify 923 elderly patients (median age, 84 years; range, 80-90) who underwent four different treatments for stage I esophageal cancer — esophagectomy, local excision, chemoradiotherapy or observation — from 2004 to 2012.
OS and postoperative mortality at 30 and 90 days served as the primary endpoints.
In total, 43% of patients underwent observation, 22% underwent chemoradiotherapy, 25% had local excision and 10% had esophagectomy.
Patients who underwent esophagectomy had a younger mean age than those observed (82 vs. 85 years, P < 0.001). Observed patients also had more comorbidities, received treatment at nonacademic centers, and lived more than 25 miles from the facility. Patients who underwent esophagectomy or local excisions tended to be white, male and in the top income quartile.
Researchers reported 5-year OS rates of 7% for patients observed, 20% for patients who underwent chemoradiotherapy, 33% for patients who underwent local excision and 45% for patients who underwent esophagectomy.
Postoperative mortality rates increased for the esophagectomy compared with local excision group at 30 days (9.6% vs. 1.3%) and 90 days (20.2% vs. 2.6%).
Multivariate analysis showed OS improved with all treatments — chemoradiotherapy (HR = 0.42; 95% CI, 0.34-0.52), local excision (HR = 0.3; 95% CI, 0.24-0.38) and esophagectomy (HR = 0.32; 95% CI, 0.23-0.44) — compared with observation.
Health disparities observed in the study, including the fact that a large proportion of patients aged older than 80 years with stage I esophageal cancer remain under clinical observation after diagnosis, are important to characterize, researchers wrote.
“Any form of local therapy, including chemoradiotherapy, statistically improved OS when compared with observation,” Moreno and colleagues wrote. “If surgery is feasible, then local excision should be considered over chemoradiotherapy and esophagectomy, give the potentially lower toxicity profile and postoperative mortality rates.” – by Chuck Gormley
Disclosure: Moreno reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.