Chemoradiation is a tolerable therapy for older adults with esophageal cancer

Introduction: 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. Patients and Methods: We retrospectively reviewed EC cases >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. Results: 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 pneumonias. 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. Conclusion: CRT was tolerable for older patients with EC. Close monitoring for dehydration, nutritional compromise and pulmonary toxicity is required.