Perioperative ECX chemotherapy in older adults with gastroesophageal adenocarcinoma

Perioperative epirubicin, cisplatin and 5-FU or capecitabine (ECF/X) chemotherapy is recognised as a standard of care for patients with resectable gastroesophageal adenocarcinoma; however, there is limited evidence regarding its use in older patients. The aims of this study were to assess the effectiveness and tolerability of perioperative ECX chemotherapy in patients aged ≥70 years-old (group 1) compared with a younger population (group 2), and to assess differences in the histology of these groups.

212 patients in our centre were treated with neoadjuvant chemotherapy for potentially resectable gastroesophageal adenocarcinoma between February 2009 and January 2014. Seventy patients (33.0%) were aged ≥70 years-old and 142 (67.0%) patients were aged under 70 years-old.

In group 1, 57 (81.4%) of patients underwent intended radical oesophagectomy or gastrectomy compared with 106 (74.6%) in group 2 (p = 0.271). The median overall survival was 35.3 months in group 1 and 30.1 months in group 2, respectively (p = 0.281). The rates of grade 3 to 4 non-haematological toxicity in groups 1 and 2 were 38.6% and 26.8%, respectively (p = 0.079). There was no difference in groups 1 and 2 regarding: pT stage, tumour grade, circumferential resection margin involvement, tumour regression grade, vascular invasion, lymphatic invasion and perineural invasion. 74.4% patients in group 2 were node-positive following chemotherapy and surgery compared with 48% in group 1 (p = 0.0015).

Selected older adults with gastroesophageal adenocarcinoma treated with perioperative ECX chemotherapy have similar overall survival and likelihood of having radical surgery as younger patients.