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Vienna, Austria

ESTRO 2023

Session Item

Upper GI
Poster (Digital)
Clinical
The value of standard chemoradiotherapy in elderly patients with adenocarcinoma of the esophagus
Nils Nicolay, Germany
PO-1367

Abstract

The value of standard chemoradiotherapy in elderly patients with adenocarcinoma of the esophagus
Authors:

Tilman Bostel1,2, Sati Akbaba3,2, Daniel Wollschläger4,2, Arnulf Mayer5,2, Eirini Nikolaidou5,2, Markus Murnik6,7, Simon Kirste6,7, Alexander Rühle6,7, Anca-Ligia Grosu6,7, Jürgen Debus8,9, Christian Fottner10,2, Markus Möhler10,2, Peter Grimminger11,2, Heinz Schmidberger5,2, Nils Henrik Nicolay12,7,13

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

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Purpose or Objective

To evaluate the tolerability and outcomes of chemoradiation in elderly patients with locally advanced adenocarcinoma of the esophagus (EACA) or gastroesophageal junction (AEG).

Material and Methods

This multi-center retrospective analysis included 86 elderly patients (≥65 years) with EACA or AEG (median age 73 years; range 65 - 92 years) treated with definitive or neoadjuvant (chemo)radiotherapy between 2006 and 2020 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 according to CTCAE criteria v5.0 were analyzed, and parameters determining patient outcomes were assessed.

Results

Thirty-three patients (38%) were treated with neoadjuvant chemoradiation followed by surgery, while the remaining patients received definitive (chemo)radiation. The delivery of radiotherapy without dose reduction was possible in 80 patients (93 %). In 66 patients (77%), concomitant chemotherapy was initially prescribed; however, during the course of therapy, 50 % of patients (n = 33) required chemotherapy de-escalation due to treatment-related toxicities and comorbidities. Twenty-nine patients (34%) experienced higher-grade acute toxicities and 14 patients (16%) higher-grade late toxicities.

The 2-year LRC, DMFS, PFS, and OS rates amounted to 72%, 49%, 46%, and 52%, respectively. On multivariate analysis, neoadjuvant chemoradiation followed by surgery was shown to significantly improve PFS (p = 0.006), DMFS (p = 0.006), and OS (p = 0.004) compared with definitive (chemo)radiation. We could not identify any clinico-pathological factor that was significantly associated with LRC. The majority of patients receiving neoadjuvant therapy received standard chemoradiotherapy without dose reduction (n = 32/33, 97%). In contrast, concurrent chemotherapy was only possible in 62% of definitive irradiated patients (n=33/53), and most of these patients required dose-reduction or modification of chemotherapy (n=32/33, 97%).  

Conclusion

In our analysis, half of the chemotherapy-eligible patients required adjustment of chemotherapy due to comorbidities or toxicities. De-escalation of therapy was mainly performed in the subgroup of patients who received definitive radiation. Therefore, the survival benefit shown for patients receiving neoadjuvant therapy is most likely due to a selection bias. Therefore, the identification of potential predictive factors for safe administration of concurrent chemotherapy in elderly EACA and AEG patients requires further exploration to optimize treatment in this vulnerable patient cohort.