Patients aged 80 years or older with early-stage esophageal cancer who received treatment had an increased 5-year overall survival (OS) compared with those who received no treatment or observation alone, according to research published in the Journal of Thoracic Oncology (published online April 2017; doi:10.1016/j.jtho.2017.04.004).
The National Comprehensive Cancer Network (NCCN) guidelines for early-stage esophageal cancer suggest surgery as the standard treatment. However, multiple factors inhibit patients from having their cancer managed surgically, such as age, comorbidities, demographics, and socioeconomic status.
Previous clinical trials have shown that survival of patients with esophageal cancer is directly associated with the degree of treatment intensity they receive. Older patients with early-stage disease tend to undergo less aggressive therapies, such as chemoradiotherapy or observation.
A group of researchers led by Amy C Moreno, MD, and Steven H Lin, MD, PhD, both from the department of radiation oncology, University of Texas MD Anderson Cancer Center, sought to analyze practice patterns, treatment-related mortality, survival, and predictors of survival in older patients (≥80 years) with stage I esophageal cancer. A total of 923 patients from 2004 to 2012 were sampled from the National Cancer Data Base and were grouped based on treatment received: observation (43%), chemoradiotherapy (22%), local excision (25%), and esophagectomy (10%). Analyses were performed on OS and postoperative 30- and 90-day mortality.
Five-year OS was 7% for those in the observation group, 20% for those in the chemoradiotherapy group, 33% for those in the local excision group, and 45% for those in the esophagectomy group. Postoperative 30-day mortality between the local excision and esophagectomy groups was 1.3% and 9.6%, respectively, and increased to 2.6% and 20.2% at 90 days.
Additionally, multivariate analysis showed improved OS across the board for all treatments when compared to observation.
Researchers concluded that “Despite high rates of observation, careful consideration of all local therapy options is warranted given improved outcomes with treatment.”
If surgery is a feasible option, researchers further suggest that local excision be recommended over chemoradiotherapy or esophagectomy because of its lower toxicity profile and postoperative mortality rates. – Zachary Bessette