Evaluation of surgery plus postoperative radiotherapy or definitive radiotherapy in older patients with thoracic esophageal squamous cell cancer

Abstract

Purpose: This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT).

Patients and methods: One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ² = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ² = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ² = 9.925; P = 0.000).

Results: Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04-76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43-33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46-3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34-0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31-0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3-4 group (HR: 2.98, 95% CI, 1.80-4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26-3.83; P = 0.006).

Conclusions: The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age.

Keywords: Age-Adjusted Charlson Comorbidity Index score; definitive; elderly; esophageal squamous cell carcinoma; postoperative; radiotherapy.