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Review
. 2021 Jan;8(1):e000492.
doi: 10.1136/bmjgast-2020-000492.

Single modality radical radiotherapy is an acceptable alternative for the older patient with squamous cell carcinoma of the oesophagus

Sarah Derby  1   2 , Matthew Forshaw  3 , Caroline Lowrie  4 , Derek Grose  4 , Husam Marashi  4 , Philip McLoone  5 , Christina Wilson  4 , David McIntosh  4
Affiliations
Review

Single modality radical radiotherapy is an acceptable alternative for the older patient with squamous cell carcinoma of the oesophagus

Sarah Derby et al. BMJ Open Gastroenterol. 2021 Jan.

Abstract

Background: Oesophageal cancer remains a common cause of cancer mortality worldwide. Increasingly, oncology centres are treating an older population and comorbidities may preclude multimodality treatment with chemoradiotherapy (CRT). We review outcomes of radical radiotherapy (RT) in an older population treating squamous cell carcinoma (SCC) oesophagus.

Methods: Patients over 65 years receiving RT for SCC oesophagus between 2013 and 2016 in the West of Scotland were identified. Kaplan-Meier and Cox-regression analysis were used to compare overall survival (OS) between patients treated with radical RT and radical CRT.

Results: There were 83 patients over 65 years treated with either RT (n=21) or CRT (n=62). There was no significant difference in median OS between CRT versus RT (26.8 months vs 28.5 months, p=0.92). All patients receiving RT completed their treatment whereas 11% of CRT patients did not complete treatment.

Conclusion: Survival in this non-trial older patient group managed with CRT is comparable to that reported in previous trials. RT shows better than expected outcomes which may reflect developments in RT technique. This review supports RT as an alternative in older patients, unfit for concurrent treatment.

Keywords: cancer; chemotherapy; oesophageal cancer; radiation therapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
An outline of patient selection and completion of treatment for all patients treated between 2013 and 2016.
Figure 2
Figure 2
(A) Median overall survival (OS) stage I—37.3 months (95% CI 35.5 to na), stage II—37.0 months (95% CI 25.7 to na), stage III—16.8 months (95% CI 12.83 to 26.7); p=0.012. (B) Median OS radiotherapy (RT): 28.5 months (95% CI 20.7 to 37.1), chemoradiotherapy (CRT): 26.8 months (95% CI 16.8 to na); p=0.79. (C) Median OS <6cm: 37.3 months (95% CI 23.8 to na), ≥6 cm: 21.6 months (95% CI 15.1 to 28.8); p=0.019. (D) Median OS completed treatment=28.8 months (95% CI 23.8 to na), did not complete treatment=9.53 months (95% CI 3.53 to 11.4); p≤0.0001; na=unable to calculate CI limit. GTV, gross tumour volume.
See this image and copyright information in PMC

References

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