Should older esophageal cancer patients get a different course of treatment?

Dr. Dan Li, The Second Affiliated Hospital of Xi'an Jiaotong University

Esophageal cancer (EC) is the eighth most common cancer and the sixth leading cause of cancer death globally. In 2020, there were 324000 new cases and 301000 related deaths of esophageal cancer in China, accounting for 53.70% and 55.35% of the global cases, respectively.

With the development of society and the aging of the population, the number of elderly patients with EC is gradually increasing. Due to the basic diseases, decreased nutritional status and body tolerance, a functional decline of various organs and other factors lead to a high risk of surgery; however, radiotherapy (RT) is more acceptable. Researchers from the Second Affiliated Hospital of Xi’an Jiaotong University aimed to discuss the treatment mode of radical radiotherapy for elderly patients with esophageal cancer.

The clinical data of 136 elderly patients, 60 years and older, with EC, who received radical intensity-modulated radiotherapy in the Second Affiliated Hospital of Xi’an Jiaotong University from January 2015 to December 2019 were retrospectively analyzed. In conclusion, ECOG score (which determines the ability of a patient to tolerate therapies in serious illness, specifically for chemotherapy), basic disease, T stage, radiation dose, chemotherapy and radiation injury were the prognostic factors of elderly patients with esophageal cancer.

Age was not a restrictive condition for treatment options and we should take into account survival benefits and patient preferences. For elderly patients with locally advanced or inoperable esophageal cancer, radical chemoradiotherapy should be considered a preferable selection. Among them, oral chemotherapy drugs and high-dose involved field irradiation exhibited better curative effects and safety.

食道癌 (EC) 是全球第八大最常見的癌症和第六大癌症死亡原因。 2020年中國食管癌新增病例32.4萬例,相關死亡病例30.1萬例,分別佔全球的53.70%和55.35%。

隨著社會的發展和人口的老齡化,老年EC患者的數量逐漸增加。由於基礎疾病、營養狀況和機體耐受力下降、各器官功能衰退等因素導致手術風險高;然而,放射治療 (RT) 更容易接受。西安交通大學第二附屬醫院的研究人員旨在探討老年食管癌根治性放療的治療模式。

回顧性分析2015年1月至2019年12月在西安交通大學第二附屬醫院接受根治性調強放療的136例60歲及以上老年EC患者的臨床資料。綜上所述,ECOG評分(決定患者在嚴重疾病中耐受治療的能力,特別是化療)、基礎疾病、T分期、放射劑量、化療和放射損傷是老年食管癌患者的預後因素。

年齡不是治療選擇的限制條件,我們應該考慮生存益處和患者偏好。對於老年局部晚期或不能手術的食管癌患者,應考慮根治性放化療。其中,口服化療藥物和大劑量介入野照射表現出較好的療效和安全性。

 

Reference: Li D, Liu X, Wang Y, Jin Y, Li F, Ma H. Intensity modulated radiation therapy for elderly patients with esophageal cancer: our experience. Bosn J of Basic Med Sci [Internet]. 2022Aug.26 [cited 2022Sep.5];. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/7835

Editor: Merima Bukva, MPharm

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