A Multi-institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients

Scott C. Lester, Steven H. Lin, Michael Chuong, Neha Bhooshan, Zhongxing Liao, Andrea L. Arnett, Sarah E. James, Jaden D. Evans, Grant M. Spears, Ritsuko Komaki, Michael Haddock, Minesh P. Mehta, Christopher Hallemeier, Kenneth W. Merrell

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Abstract

Purpose The therapeutic gains of neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy may be offset by increased incidences of morbidity and mortality in elderly patients. This study aimed to determine the impact of age on the risks and benefits of trimodality therapy for esophageal cancer. Methods and Materials We evaluated 571 patients treated with trimodality therapy at 3 high-volume tertiary cancer centers in the United States from 2007 to 2013. Two hundred two of 571 (35%) patients were 65 years or older at diagnosis and were classified as elderly. Toxicity and treatment parameters for the elderly cohort were compared with the younger cohort (ages 22-64) by the use of univariate (UVA) and multivariable (MVA) logistic analyses. Age was analyzed as a continuous hazard for cardiac and pulmonary toxicities. Survival was assessed by the Kaplan-Meier method. Results Elderly patients had a higher risk for postoperative cardiac toxicities (UVA: odds ratio [OR] 2.2, P<.001; MVA: OR 2.07, P=.004) and pulmonary toxicities (UVA: OR 2.0, P<.001; MVA: OR 2.03, P<.001) and a higher 90-day postoperative mortality (5.4% vs 2.2%, P=.049). Of the elderly patients, 6.9% experienced acute respiratory distress syndrome compared with 3.8% of younger patients (P=.11). Cardiac toxicity was linearly associated with age, and the relative risk increased by 61% for every additional decade of age. There was no difference in postoperative gastrointestinal or wound adverse events or in length of hospital stay. Grade 3+ acute toxicities from nCRT were infrequent and were clinically similar regardless of age. Freedom from esophageal cancer and disease-free survival were similar, but overall survival was significantly shorter in the elderly cohort. Conclusions Elderly patients experienced more postoperative cardiopulmonary toxicities and mortality than did younger patients after nCRT. Compared with contemporary outcomes for trimodality therapy, both cohorts had acceptable rates for adverse events and disease control. For appropriately selected elderly patients, trimodality therapy for esophageal cancer is a reasonable treatment option.

Original languageEnglish (US)
Pages (from-to)820-828
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume98
Issue number4
DOIs
StatePublished - Jul 15 2017

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Esophageal Neoplasms
therapy
cancer
toxicity
Neoadjuvant Therapy
mortality
Odds Ratio
Therapeutics
Mortality
Length of Stay
Esophageal Diseases
Lung
Esophagectomy
Survival
Adult Respiratory Distress Syndrome
logistics
guy wires
hazards
Disease-Free Survival
grade

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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A Multi-institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients. / Lester, Scott C.; Lin, Steven H.; Chuong, Michael; Bhooshan, Neha; Liao, Zhongxing; Arnett, Andrea L.; James, Sarah E.; Evans, Jaden D.; Spears, Grant M.; Komaki, Ritsuko; Haddock, Michael; Mehta, Minesh P.; Hallemeier, Christopher; Merrell, Kenneth W.

In: International Journal of Radiation Oncology Biology Physics, Vol. 98, No. 4, 15.07.2017, p. 820-828.

Research output: Contribution to journalArticle

Lester, SC, Lin, SH, Chuong, M, Bhooshan, N, Liao, Z, Arnett, AL, James, SE, Evans, JD, Spears, GM, Komaki, R, Haddock, M, Mehta, MP, Hallemeier, C & Merrell, KW 2017, 'A Multi-institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients', International Journal of Radiation Oncology Biology Physics, vol. 98, no. 4, pp. 820-828. https://doi.org/10.1016/j.ijrobp.2017.02.021
Lester, Scott C. ; Lin, Steven H. ; Chuong, Michael ; Bhooshan, Neha ; Liao, Zhongxing ; Arnett, Andrea L. ; James, Sarah E. ; Evans, Jaden D. ; Spears, Grant M. ; Komaki, Ritsuko ; Haddock, Michael ; Mehta, Minesh P. ; Hallemeier, Christopher ; Merrell, Kenneth W. / A Multi-institutional Analysis of Trimodality Therapy for Esophageal Cancer in Elderly Patients. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 98, No. 4. pp. 820-828.
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abstract = "Purpose The therapeutic gains of neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy may be offset by increased incidences of morbidity and mortality in elderly patients. This study aimed to determine the impact of age on the risks and benefits of trimodality therapy for esophageal cancer. Methods and Materials We evaluated 571 patients treated with trimodality therapy at 3 high-volume tertiary cancer centers in the United States from 2007 to 2013. Two hundred two of 571 (35{\%}) patients were 65 years or older at diagnosis and were classified as elderly. Toxicity and treatment parameters for the elderly cohort were compared with the younger cohort (ages 22-64) by the use of univariate (UVA) and multivariable (MVA) logistic analyses. Age was analyzed as a continuous hazard for cardiac and pulmonary toxicities. Survival was assessed by the Kaplan-Meier method. Results Elderly patients had a higher risk for postoperative cardiac toxicities (UVA: odds ratio [OR] 2.2, P<.001; MVA: OR 2.07, P=.004) and pulmonary toxicities (UVA: OR 2.0, P<.001; MVA: OR 2.03, P<.001) and a higher 90-day postoperative mortality (5.4{\%} vs 2.2{\%}, P=.049). Of the elderly patients, 6.9{\%} experienced acute respiratory distress syndrome compared with 3.8{\%} of younger patients (P=.11). Cardiac toxicity was linearly associated with age, and the relative risk increased by 61{\%} for every additional decade of age. There was no difference in postoperative gastrointestinal or wound adverse events or in length of hospital stay. Grade 3+ acute toxicities from nCRT were infrequent and were clinically similar regardless of age. Freedom from esophageal cancer and disease-free survival were similar, but overall survival was significantly shorter in the elderly cohort. Conclusions Elderly patients experienced more postoperative cardiopulmonary toxicities and mortality than did younger patients after nCRT. Compared with contemporary outcomes for trimodality therapy, both cohorts had acceptable rates for adverse events and disease control. For appropriately selected elderly patients, trimodality therapy for esophageal cancer is a reasonable treatment option.",
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AU - Chuong, Michael

AU - Bhooshan, Neha

AU - Liao, Zhongxing

AU - Arnett, Andrea L.

AU - James, Sarah E.

AU - Evans, Jaden D.

AU - Spears, Grant M.

AU - Komaki, Ritsuko

AU - Haddock, Michael

AU - Mehta, Minesh P.

AU - Hallemeier, Christopher

AU - Merrell, Kenneth W.

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N2 - Purpose The therapeutic gains of neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy may be offset by increased incidences of morbidity and mortality in elderly patients. This study aimed to determine the impact of age on the risks and benefits of trimodality therapy for esophageal cancer. Methods and Materials We evaluated 571 patients treated with trimodality therapy at 3 high-volume tertiary cancer centers in the United States from 2007 to 2013. Two hundred two of 571 (35%) patients were 65 years or older at diagnosis and were classified as elderly. Toxicity and treatment parameters for the elderly cohort were compared with the younger cohort (ages 22-64) by the use of univariate (UVA) and multivariable (MVA) logistic analyses. Age was analyzed as a continuous hazard for cardiac and pulmonary toxicities. Survival was assessed by the Kaplan-Meier method. Results Elderly patients had a higher risk for postoperative cardiac toxicities (UVA: odds ratio [OR] 2.2, P<.001; MVA: OR 2.07, P=.004) and pulmonary toxicities (UVA: OR 2.0, P<.001; MVA: OR 2.03, P<.001) and a higher 90-day postoperative mortality (5.4% vs 2.2%, P=.049). Of the elderly patients, 6.9% experienced acute respiratory distress syndrome compared with 3.8% of younger patients (P=.11). Cardiac toxicity was linearly associated with age, and the relative risk increased by 61% for every additional decade of age. There was no difference in postoperative gastrointestinal or wound adverse events or in length of hospital stay. Grade 3+ acute toxicities from nCRT were infrequent and were clinically similar regardless of age. Freedom from esophageal cancer and disease-free survival were similar, but overall survival was significantly shorter in the elderly cohort. Conclusions Elderly patients experienced more postoperative cardiopulmonary toxicities and mortality than did younger patients after nCRT. Compared with contemporary outcomes for trimodality therapy, both cohorts had acceptable rates for adverse events and disease control. For appropriately selected elderly patients, trimodality therapy for esophageal cancer is a reasonable treatment option.

AB - Purpose The therapeutic gains of neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy may be offset by increased incidences of morbidity and mortality in elderly patients. This study aimed to determine the impact of age on the risks and benefits of trimodality therapy for esophageal cancer. Methods and Materials We evaluated 571 patients treated with trimodality therapy at 3 high-volume tertiary cancer centers in the United States from 2007 to 2013. Two hundred two of 571 (35%) patients were 65 years or older at diagnosis and were classified as elderly. Toxicity and treatment parameters for the elderly cohort were compared with the younger cohort (ages 22-64) by the use of univariate (UVA) and multivariable (MVA) logistic analyses. Age was analyzed as a continuous hazard for cardiac and pulmonary toxicities. Survival was assessed by the Kaplan-Meier method. Results Elderly patients had a higher risk for postoperative cardiac toxicities (UVA: odds ratio [OR] 2.2, P<.001; MVA: OR 2.07, P=.004) and pulmonary toxicities (UVA: OR 2.0, P<.001; MVA: OR 2.03, P<.001) and a higher 90-day postoperative mortality (5.4% vs 2.2%, P=.049). Of the elderly patients, 6.9% experienced acute respiratory distress syndrome compared with 3.8% of younger patients (P=.11). Cardiac toxicity was linearly associated with age, and the relative risk increased by 61% for every additional decade of age. There was no difference in postoperative gastrointestinal or wound adverse events or in length of hospital stay. Grade 3+ acute toxicities from nCRT were infrequent and were clinically similar regardless of age. Freedom from esophageal cancer and disease-free survival were similar, but overall survival was significantly shorter in the elderly cohort. Conclusions Elderly patients experienced more postoperative cardiopulmonary toxicities and mortality than did younger patients after nCRT. Compared with contemporary outcomes for trimodality therapy, both cohorts had acceptable rates for adverse events and disease control. For appropriately selected elderly patients, trimodality therapy for esophageal cancer is a reasonable treatment option.

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