Safety of radiotherapy with concurrent docetaxel in older patients with esophageal cancer

• Published in: Journal of geriatric oncology Vol. 11; no. 4; pp. 675 - 679
• Main Authors: Kawamoto, Terufumi, Shikama, Naoto, Oshima, Masaki, Kosugi, Yasuo, Tsurumaru, Masahiko, Sasai, Keisuke
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.05.2020
• Subjects: Chemoradiotherapy; Esophageal cancer; Hematology, Oncology, and Palliative Medicine; Internal Medicine; Older patients; RT; CRT; FP; HR; Chemoradiotherapy; Eastern Cooperative Oncology Group performance status; docetaxel; University Hospital Medical Information Network; geriatric nutritional risk index; overall survival; DOC; UMIN; PFS; EC; OS; CI; progression-free survival; CCI; Charlson Comorbidity Index; MST; ECOG PS; 5-fluorouracil and cisplatin; median survival time; Older patients; hazard ratio; radiotherapy; confidence interval; Esophageal cancer; GNRI
• ISSN: 1879-4068; 1879-4076
• DOI: 10.1016/j.jgo.2019.08.009

AbstractObjectivesConsidering that therapeutic strategies for older adult patients with esophageal cancer (EC) remain controversial, we aimed to assess the safety of radiotherapy with concurrent docetaxel (DOC-RT) among older adult patients with EC. Materials and MethodsEligible patients included those aged ≥76 years who were diagnosed with esophageal squamous cell carcinoma. Patients received radiotherapy (60 Gy in 30 fractions) and concurrent docetaxel (10 mg/m 2 weekly for six cycles). Survival, toxicity, and treatment completion rates were retrospectively evaluated. ResultsAmong 84 older adult patients receiving radical radiotherapy or chemoradiotherapy, 73 receiving DOC-RT were studied. Median follow-up duration was 14 months (range, 2–101 months). The 1-, 3-, and 5-year overall survival rates were 63%, 33%, and 13%, respectively, with a median survival time of 21 months. Grade 3 acute toxicities included esophagitis (7%), esophageal fistula (3%), pneumonitis (1%), leukopenia (10%), and anemia (8%). Grade 3 late toxicities included esophageal stenosis (4%), pleural effusion (3%), pericardial effusion (1%), and pneumonitis (1%). Grade 4 and 5 toxicities were not observed. DOC-RT was discontinued due to deterioration in the general condition (6%), esophageal fistula (3%), pneumonia (1%), and pain (1%), resulting in a DOC-RT completion rate of 89% (65/73 patients). The non-completion group comprised a higher proportion of older adults (age ≥ 80 years) and undernourished [geriatric nutritional risk index (GNRI <92)] patients than the completion group. ConclusionDOC-RT can be a safe regimen for older adult patients with EC. Nonetheless, old age (≥80 years) and undernourishment (GNRI <92) should be considered prior to DOC-RT administration.