Management and outcomes of localized esophageal and gastroesophageal junction cancer in older patients

  • X. Qu Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
  • J. Biagi Queen's University,Cancer Centre of Southeastern Ontario at Kingston General Hospital
  • A. Banashkevich Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
  • C.D. Mercer Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
  • L. Tremblay Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
  • A. Mahmud Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Keywords: Older patients, esophageal cancer, chemoradiation therapy

Abstract

Background

Older patients are commonly excluded from clinical trials in esophageal and gastroesophageal junction (gej) cancer. High-level evidence to guide management in this group is lacking. In the present study, we compared outcomes and described tolerance for curative- and noncurative-intent treatments among patients 70 years of age and older.

Methods

We retrospectively reviewed all patients 70 years of age and older diagnosed with localized esophageal and gej cancer at our centre between 2005 and 2012.

Results

The 74 patients identified had a median age of 77 years. Of those patients, 62% received curative-intent treatment, consisting mostly of concomitant chemoradiation therapy (n = 43, 93%). Median overall survival for patients receiving curative-intent treatment was 18.6 months [95% confidence interval (ci): 13.0 to 28.0 months], with 23% being long-term survivors (95% ci: 11.3% to 36.7%). In contrast, patients receiving noncurative-intent treatment had a median overall survival of 8.8 months (95% ci: 6.7 to 11.9 months), with none being long-term survivors (p < 0.0001). Improvement of dysphagia was seen after curative (81%) or palliative radiotherapy (78%) in symptomatic patients, and toxicities were manageable. The odds of not receiving curative treatment was higher by a factor of 8.5 among patients 80 years of age or older compared with those 70–79 years of age (95% ci: 2.5 to 28.7).

Conclusions

In managing older patients with esophageal and gej cancer, curative-intent treatment (compared with noncurative-intent treatment) leads to a significant survival benefit with a reasonable toxicity profile. Informed counselling of patients and their families about a curative treatment approach and efforts to increase awareness among oncology care providers are suggested.


Author Biographies

X. Qu, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Oncology
J. Biagi, Queen's University,Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Oncology
A. Banashkevich, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Oncology
C.D. Mercer, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Surgery
L. Tremblay, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Oncology
A. Mahmud, Queen’s University, Cancer Centre of Southeastern Ontario at Kingston General Hospital
Department of Oncology
Published
2015-09-11
How to Cite
Qu, X., Biagi, J., Banashkevich, A., Mercer, C., Tremblay, L., & Mahmud, A. (2015). Management and outcomes of localized esophageal and gastroesophageal junction cancer in older patients. Current Oncology, 22(6), e435-e442. https://doi.org/10.3747/co.22.2661
Section
Geriatric Oncology