Palliative External Beam Radiation Therapy for Dysphagia in a 101-Year-Old Man With Esophageal Adenocarcinoma

Esophageal adenocarcinoma in centenarians is rare, and treatment options in this age group are limited. Dysphagia is often the predominant symptom that affects quality of life (QoL), and options for treatment and palliation are limited when patients are not candidates for chemoradiation and endoscopic interventions fail. We present the case of a 101-year-old male patient with symptomatic distal gastroesophageal junction (GEJ) adenocarcinoma who presented with progressive dysphagia, aspiration, and weight loss. Esophagogastroduodenoscopy (EGD) was performed to confirm the diagnosis and to place a metal stent for obstruction. He was deemed medically unsuitable for definitive chemoradiation or surgery, with goals of care to avoid an enteric feeding tube for nutrition and prolong life while maintaining his QoL. The metal stent had migrated, providing limited improvement and progression in dysphagia, and physicians in a multidisciplinary review recommended that he proceed with either hospice or palliative radiation therapy. The patient underwent palliative external beam radiation therapy (EBRT) to a total dose of 37.5 Gy in 15 fractions, targeting the obstructive esophageal mass with a margin using volumetric-modulated arc therapy (VMAT) technique. The treatment was well tolerated by the patient with no significant acute toxicity. After treatment, the patient reported clinically meaningful improvement in functional status, with improved swallowing, advancing from liquids to a soft diet, weight gain, and improved QoL. Moderate-dose palliative radiation can be a safe and effective treatment in a centenarian with obstructive GEJ adenocarcinoma, particularly when endoscopic interventions are not successful or durable. This report shows the importance of shared decision-making in geriatric oncology, where performance status and goals of care guide the selection of treatment options, and supports the use of palliative EBRT in the centarian population as a successful modality to improve swallowing and QoL in carefully selected patients with dysphagia secondary to malignancy.