Chemoradiation is a tolerable therapy for older adults with esophageal cancer

Esophageal adenocarcinoma (EC) is increasing in incidence. Chemoradiation (CRT) is regarded as an acceptable alternative to surgery for the management of locally advanced EC. Ten-20% of EC patients are over the age of 75 years. There are limited data regarding efficacy and tolerability of CRT for the treatment of EC in the elderly.

We retrospectively reviewed EC cases > or = 70 years of age treated with CRT at a single institution. Clinical data, regarding therapy administered and outcome, were obtained from records. Clinical prognostic variables were analyzed against survival in a univariate model using the log rank test and in a multivariate model using Cox proportional hazards analysis.

Thirty consecutive patient records were identified. Commonly used chemotherapy agents included 5-fluorouracil, cisplatin, paclitaxel and oxaliplatin. There was no significant correlation between age and survival. The dose of chemotherapy or radiation was unrelated to any of the toxicities (p-values > 0.16). The most common grade 3 or 4 toxicities were dehydration, hypotension, mucositis and pneumonitis. On multivariate analysis, adenocarcinoma histology (p = 0.0094) and higher radiation dose (p = 0.0158) were associated with improved survival. The median survival of the patients was 10 months.

CRT was tolerable for older patients with EC. Close monitoring for dehydration, nutritional compromise and pulmonary toxicity is required.