Practical Implementation and Validation of Geriatric Assessment in Older Adults With Esophageal Cancer

Esophageal squamous cell carcinoma (ESCC) is associated with poor prognosis, and older adults frequently present with frailty and comorbidities that complicate multimodal treatment. Although international guidelines recommend geriatric assessment (GA) to guide treatment decisions, clinical application in esophageal cancer remains limited in Japan. This study aimed to investigate the feasibility and clinical impact of GA in older adults with ESCC.

Forty patients aged ≥70 years with newly diagnosed esophageal cancer underwent GA at admission. The assessment included the Geriatric 8 (G8), Cancer and Aging Research Group (CARG) score, and Robinson Frailty Score (RFS). For patients with stage II-III ESCC, treatment strategies and chemotherapy intensity were determined through multidisciplinary team discussions that incorporated GA findings. Clinical data, chemotherapy-related adverse events (AEs), and perioperative outcomes were analyzed.

Among the 40 patients, 22 with stage II-III ESCC qualified for treatment intensity analysis. Ten patients received GA-based reduced-intensity chemotherapy. Although the incidence of chemotherapy-related AEs did not differ significantly between the reduced- and standard-intensity groups, patients who received reduced-intensity regimens experienced significantly reduced the frequency of postoperative complications (p=0.024). Reduction in treatment intensity did not prolong operative time, increase intraoperative blood loss, nor extend hospital stay. GA scores did not directly correlate with AEs, but did guide treatment de-escalation and surgical candidacy decisions.

GA-based treatment modification is feasible for older adults with ESCC and helps reduce postoperative complications without compromising short-term oncological outcomes. These findings support incorporating GA into routine clinical practice to enhance treatment safety and individualize care for this population.