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Vienna, Austria

ESTRO 2023

Session Item

Upper GI
Poster (Digital)
Clinical
The value of chemoradiotherapy in elderly patients with squamous cell carcinoma of the esophagus
Nils Nicolay, Germany
PO-1349

Abstract

The value of chemoradiotherapy in elderly patients with squamous cell carcinoma of the esophagus
Authors:

Tilman Bostel1,2, Sati Akbaba3,2, Daniel Wollschläger4,5, Arnulf Mayer3,6, Eirini Nikolaidou3,7, Markus Murnik8,9, Simon Kirste8,9, Alexander Rühle8,9, Anca-Ligia Grosu8,9, Jürgen Debus10,11, Christian Fottner12,2, Markus Möhler12,7, Peter Grimminger13,2, Heinz Schmidberger3,2, Nils Henrik Nicolay8,9,14

1University Medical Center Mainz, Department of Radiation Oncology , Mainz, Germany; 2German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg, Germany; 3University Medical Center Mainz , Department of Radiation Oncology , Mainz , Germany; 4University Medical Center Mainz , Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz , Germany; 5German Cancer Research Center Mainz (dkfz), German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg, Germany; 6German Cancer Research Center Mainz , German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg, Germany; 7German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Mainz, Heidelberg , Germany; 8University of Freiburg – Medical Center, Department of Radiation Oncology , Freiburg, Germany; 9German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Heidelberg, Germany; 10University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg, Germany; 11German Cancer Research Center (dkfz), German Cancer Consortium (DKTK) Partner Site Heidelberg, Heidelberg, Germany; 12University Medical Center Mainz , Department of Internal Medicine I, Mainz, Germany; 13University Medical Center Mainz , Department of General, Visceral and Transplant Surgery, Mainz , Germany; 14University of Leipzig Medical Center, Department of Radiation Oncology , Leipzig, Germany

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Purpose or Objective

To analyze the tolerability and outcomes of chemoradiotherapy in elderly patients with locally advanced esophageal squamous cell carcinoma (ESCC).

Material and Methods

This multi-center retrospective analysis included 161 elderly patients with ESCC (median age 73 years, range 65-89 years) who were treated with definitive or neoadjuvant (chemo)radiotherapy in the period 2010 to 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

Radiotherapy was delivered as initially planned to most patients (n=149, 93%). In 134 patients (83%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 41 % of these patients (n = 55) required de-escalation of chemotherapy due to comorbidities and 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 were 67.5%, 33.8%, 31.4%, and 40.4%, respectively. On multivariate analysis, full-dose concomitant chemotherapy (vs. no or modified chemotherapy) significantly improved 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) was significantly associated with improved PFS (p=0.043) and OS (p=0.049). We could not identify any clinico-pathological factors 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 treatment, with a higher risk for late toxicities when neoadjuvant chemoradiation was switched to definitive chemoradiation compared to definitive (chemo)radiation (p<0.001).

Conclusion

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 the upfront selection of concurrent chemotherapy in elderly ESCC patients is crucial and requires further exploration to optimize treatment in this vulnerable patient cohort.