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Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly

BACKGROUND AND PURPOSE: To evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: This multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age o...

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Autores principales: Bostel, Tilman, Akbaba, Sati, Wollschläger, Daniel, Mayer, Arnulf, Nikolaidou, Eirini, Murnik, Markus, Kirste, Simon, Rühle, Alexander, Grosu, Anca-Ligia, Debus, Jürgen, Fottner, Christian, Moehler, Markus, Grimminger, Peter, Schmidberger, Heinz, Nicolay, Nils Henrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022427/
https://www.ncbi.nlm.nih.gov/pubmed/36937445
http://dx.doi.org/10.3389/fonc.2023.1063670
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author Bostel, Tilman
Akbaba, Sati
Wollschläger, Daniel
Mayer, Arnulf
Nikolaidou, Eirini
Murnik, Markus
Kirste, Simon
Rühle, Alexander
Grosu, Anca-Ligia
Debus, Jürgen
Fottner, Christian
Moehler, Markus
Grimminger, Peter
Schmidberger, Heinz
Nicolay, Nils Henrik
author_facet Bostel, Tilman
Akbaba, Sati
Wollschläger, Daniel
Mayer, Arnulf
Nikolaidou, Eirini
Murnik, Markus
Kirste, Simon
Rühle, Alexander
Grosu, Anca-Ligia
Debus, Jürgen
Fottner, Christian
Moehler, Markus
Grimminger, Peter
Schmidberger, Heinz
Nicolay, Nils Henrik
author_sort Bostel, Tilman
collection PubMed
description BACKGROUND AND PURPOSE: To evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: This multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed. RESULTS: The delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001). CONCLUSIONS: Chemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort.
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spelling pubmed-100224272023-03-18 Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly Bostel, Tilman Akbaba, Sati Wollschläger, Daniel Mayer, Arnulf Nikolaidou, Eirini Murnik, Markus Kirste, Simon Rühle, Alexander Grosu, Anca-Ligia Debus, Jürgen Fottner, Christian Moehler, Markus Grimminger, Peter Schmidberger, Heinz Nicolay, Nils Henrik Front Oncol Oncology BACKGROUND AND PURPOSE: To evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC). MATERIALS AND METHODS: This multi-center retrospective analysis included 161 patients with SCC of the esophagus with a median age of 73 years (range 65-89 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2010 and 2019 at 3 large comprehensive cancer centers in Germany. Locoregional control (LRC), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and treatment-associated toxicities were analyzed, and parameters determining patient outcomes and treatment tolerance were assessed. RESULTS: The delivery of radiotherapy without dose reduction was possible in 149 patients (93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41% of these patients (n = 55) required chemotherapy de-escalation due to treatment-related toxicities. Fifty-two patients (32%) experienced higher-grade acute toxicities, and 22 patients (14%) higher-grade late toxicities. The 2-year LRC, DMFS, PFS, and OS rates amounted to 67.5%, 33.8%, 31.4%, and 40.4%, respectively. Upon multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) was associated with significantly better DMFS (p=0.005), PFS (p=0.005) and OS (p=0.001). Furthermore, neoadjuvant chemoradiotherapy followed by tumor resection (vs. definitive chemoradiotherapy or definitive radiotherapy alone) significantly improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factor that was significantly associated with LRC. Furthermore, definitive (chemo)radiotherapy, brachytherapy boost and stent implantation were significantly associated with higher-grade acute toxicities (p<0.001, p=0.002 and p=0.04, respectively). The incidence of higher-grade late toxicities was also significantly associated with the choice of therapy, with a higher risk for late toxicities when treatment was switched from neoadjuvant to definitive (chemo)radiotherapy compared to primary definitive (chemo)radiotherapy (p<0.001). CONCLUSIONS: Chemoradiation with full-dose and unmodified concurrent chemotherapy has a favorable prognostic impact in elderly ESCC patients; however, about half of the analyzed patients required omission or adjustment of chemotherapy due to comorbidities or toxicities. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly ESCC patients requires further exploration to optimize treatment in this vulnerable patient cohort. Frontiers Media S.A. 2023-03-03 /pmc/articles/PMC10022427/ /pubmed/36937445 http://dx.doi.org/10.3389/fonc.2023.1063670 Text en Copyright © 2023 Bostel, Akbaba, Wollschläger, Mayer, Nikolaidou, Murnik, Kirste, Rühle, Grosu, Debus, Fottner, Moehler, Grimminger, Schmidberger and Nicolay https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Bostel, Tilman
Akbaba, Sati
Wollschläger, Daniel
Mayer, Arnulf
Nikolaidou, Eirini
Murnik, Markus
Kirste, Simon
Rühle, Alexander
Grosu, Anca-Ligia
Debus, Jürgen
Fottner, Christian
Moehler, Markus
Grimminger, Peter
Schmidberger, Heinz
Nicolay, Nils Henrik
Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title_full Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title_fullStr Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title_full_unstemmed Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title_short Chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: Multi-center analysis on the value of standard treatment in the elderly
title_sort chemoradiotherapy in geriatric patients with squamous cell carcinoma of the esophagus: multi-center analysis on the value of standard treatment in the elderly
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10022427/
https://www.ncbi.nlm.nih.gov/pubmed/36937445
http://dx.doi.org/10.3389/fonc.2023.1063670
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