Trimodality CROSS regimen outcomes in older adults with locally advanced esophageal cancer

Aaron Dezube, MD
Department of Surgery
Division of Thoracic Surgery
Poster Overview

Background: Currently, chemotherapy and radiation followed by surgery is recommended for treatment of locally advanced esophageal cancer.

Methods: We looked at differences in how older adults diagnosed with cancer of their esophagus (70 or older years old) as compared to younger patients completed chemotherapy and radiation treatment and recovered after surgical removal of their esophagus at Brigham and Women’s Hospital

Results: 201 patients were studied. 136 were <70 yrs and 65 were ≥ 70 yrs. Older adults were likelier to be male and have more underlying health problems.

Older adults were just as likely as younger patients to finish their treatment before surgery. However, sometimes they needed a lower chemotherapy dose due to side effects. Younger patients had more gastrointestinal side effects. Additionally, the time from their chemotherapy and radiation finishing to when they underwent surgery was similar, except in patients 80 years or older.

Older adults following surgery experienced more confusion and difficulty peeing but otherwise recovered the same as younger patients in terms of need for rehabilitation, how long they stayed in the hospital, and complications.

Conclusion: Older adults’ tolerate chemotherapy, radiation and surgery for esophageal cancer often as well as younger patients.

Scientific Abstract

Background: We evaluated differences in neoadjuvant chemoradiation completion rates, toxicity, and postoperative outcomes between older and younger adults receiving CROSS trimodality therapy for esophageal cancer.

Methods: Retrospective analysis of locally-advanced esophageal cancer patients who underwent CROSS trimodality therapy from May 2016 to January 2020 at BWH. Patients were divided into those aged2 70 years old and <70 years-old).

Results: Of 201 patients, 136 were <70 yrs and 65 were ≥ 70 yrs. Older adults were more likely to be male, have higher ECOG scores, and Charlson comorbidity index, and undergo an open procedure (all p<0.05).

Treatment completion and discontinuation rates were similar between those aged > 70 years and < 70 (78% vs. 83% and 6% vs 10% respectively; p<0.05). Dose reduction rates were higher in older adults (15% vs. 7%, p=0.047). Time to surgery following neoadjuvant therapy was similar, except in those 280-years-old (p<0.05). Toxicity rates were similar except for gastrointestinal toxicity (29% older vs. 52%; p=0.002). Older patients had higher post-operative rates of delirium and urinary retention (both p<0.05). Hospital LOS, discharge disposition, mortality, and median survival were similar.

Conclusion: Trimodality CROSS therapy for esophageal cancer in older adults is feasible, with similar outcomes as compared to younger counterparts.

Clinical Implications
Age alone should not prohibit older adults over 70 years old from receiving recommended chemotherapy, radiation and removal of their esophagus to treat their esophageal cancer if they are suited for it.
Research Areas
Authors
Aaron Dezube MD, Lisa Cooper MD, Luis E. De León MD, Suden Kucukak MD, Emanuele Mazzola PhD, Clark Dumontier MD, Harvey Mamon MD, PhD, Peter Enzinger MD, Michael T. Jaklitsch MD, Laura Frain MD, Jon O. Wee MD
Principal Investigator
Jon O. Wee, MD

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