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Published in: BMC Cancer 1/2010

Open Access 01-12-2010 | Research article

Esophageal cancer in the elderly: an analysis of the factors associated with treatment decisions and outcomes

Authors: David Tougeron, Hadji Hamidou, Michel Scotté, Frédéric Di Fiore, Michel Antonietti, Bernard Paillot, Pierre Michel

Published in: BMC Cancer | Issue 1/2010

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Abstract

Background

Only limited data has been reported so far regarding oesophageal cancer (EC) in elderly patients. The aim of the study is to identify the baseline parameters that influenced therapeutic decision.

Methods

All consecutive patients 70 years or older being treated for EC were retrospectively analyzed. Patients without visceral metastasis were divided into two groups: treatment with curative intent (chemoradiotherapy, surgery, radiotherapy, mucosectomy or photodynamic therapy) or best supportive care (BSC). Patients with metastasis were divided into two groups: palliative treatment (chemotherapy, chemoradiotherapy or radiotherapy) or BSC.

Results

Two hundred and eighty-two patients were studied. Mean age was 76.5 ± 5.5 years and 22.4% of patients had visceral metastasis. In patients without visceral metastasis (n = 220) the majority had treatment with curative intent (n = 151) whereas in patients with metastasis (n = 62) the majority had BSC (n = 32). Severe adverse events (≥ grade 3) were observed in only 17% of the patients. Patients without specific carcinologic treatment were older, had more weight loss, worse WHO performance status and Charlson score in multivariate analysis.

Discussion

Our results suggest that elderly patients with an EC could benefit from cancer treatment without major toxicities. Weight loss, WHO performance status and the Charlson score could be used to select the appropriate treatment in an elderly patient.
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Literature
1.
go back to reference Trivers KF, Sabatino SA, Stewart SL: Trends in esophageal cancer incidence by histology, United States, 1998-2003. Int J Cancer. 2008, 123: 1422-8. 10.1002/ijc.23691.CrossRefPubMed Trivers KF, Sabatino SA, Stewart SL: Trends in esophageal cancer incidence by histology, United States, 1998-2003. Int J Cancer. 2008, 123: 1422-8. 10.1002/ijc.23691.CrossRefPubMed
2.
go back to reference Remontet L, Estève J, Bouvier AM, Grosclaude P, Launoy G, Menegoz F, Exbrayat C, Tretare B, Carli PM, Guizard AV, Troussard X, Bercelli P, Colonna M, Halna JM, Hedelin G, Macé-Lesec'h J, Peng J, Buemi A, Velten M, Jougla E, Arveux P, Le Bodic L, Michel E, Sauvage M, Schvartz C, Faivre J: Cancer incidence and mortality in France over the period 1978-2000. Rev Epidemiol Sante Publique. 2003, 51: 3-30.PubMed Remontet L, Estève J, Bouvier AM, Grosclaude P, Launoy G, Menegoz F, Exbrayat C, Tretare B, Carli PM, Guizard AV, Troussard X, Bercelli P, Colonna M, Halna JM, Hedelin G, Macé-Lesec'h J, Peng J, Buemi A, Velten M, Jougla E, Arveux P, Le Bodic L, Michel E, Sauvage M, Schvartz C, Faivre J: Cancer incidence and mortality in France over the period 1978-2000. Rev Epidemiol Sante Publique. 2003, 51: 3-30.PubMed
3.
go back to reference Bouvier AM, Launoy G, Lepage C, Faivre J: Trends in the management and survival of digestive tract cancers among patients aged over 80 years. Aliment Pharmacol Ther. 2005, 22: 233-41. 10.1111/j.1365-2036.2005.02559.x.CrossRefPubMed Bouvier AM, Launoy G, Lepage C, Faivre J: Trends in the management and survival of digestive tract cancers among patients aged over 80 years. Aliment Pharmacol Ther. 2005, 22: 233-41. 10.1111/j.1365-2036.2005.02559.x.CrossRefPubMed
4.
go back to reference Steyerberg EW, Neville B, Weeks JC, Earle CC: Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2007, 25: 2389-96. 10.1200/JCO.2006.09.7931.CrossRefPubMed Steyerberg EW, Neville B, Weeks JC, Earle CC: Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2007, 25: 2389-96. 10.1200/JCO.2006.09.7931.CrossRefPubMed
5.
go back to reference Law S, Wong KH, Kwok KF, Chu KM, Wong J: Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004, 240: 791-800. 10.1097/01.sla.0000143123.24556.1c.CrossRefPubMedPubMedCentral Law S, Wong KH, Kwok KF, Chu KM, Wong J: Predictive factors for postoperative pulmonary complications and mortality after esophagectomy for cancer. Ann Surg. 2004, 240: 791-800. 10.1097/01.sla.0000143123.24556.1c.CrossRefPubMedPubMedCentral
6.
go back to reference Stahl M, Oliveira J, ESMO Guidelines Working Group: Esophageal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008, 19 (Suppl 2): ii21-2. 10.1093/annonc/mdn074.PubMed Stahl M, Oliveira J, ESMO Guidelines Working Group: Esophageal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008, 19 (Suppl 2): ii21-2. 10.1093/annonc/mdn074.PubMed
7.
go back to reference Kleinberg L, Forastiere AA: Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007, 25: 4110-7. 10.1200/JCO.2007.12.0881.CrossRefPubMed Kleinberg L, Forastiere AA: Chemoradiation in the management of esophageal cancer. J Clin Oncol. 2007, 25: 4110-7. 10.1200/JCO.2007.12.0881.CrossRefPubMed
8.
go back to reference Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz JF, Herr JP, Paillot B, Arveux P, Bonnetain F, Binquet C: Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007, 25: 1160-8. 10.1200/JCO.2005.04.7118.CrossRefPubMed Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz JF, Herr JP, Paillot B, Arveux P, Bonnetain F, Binquet C: Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007, 25: 1160-8. 10.1200/JCO.2005.04.7118.CrossRefPubMed
9.
go back to reference Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005, 23: 2310-2317. 10.1200/JCO.2005.00.034.CrossRefPubMed Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H: Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005, 23: 2310-2317. 10.1200/JCO.2005.00.034.CrossRefPubMed
10.
go back to reference Anderson SE, Minsky BD, Bains M, Hummer A, Kelsen D, Ilson DH: Combined modality chemoradiation in elderly oesophageal cancer patients. Br J Cancer. 2007, 96: 1823-1827. 10.1038/sj.bjc.6603821.CrossRefPubMedPubMedCentral Anderson SE, Minsky BD, Bains M, Hummer A, Kelsen D, Ilson DH: Combined modality chemoradiation in elderly oesophageal cancer patients. Br J Cancer. 2007, 96: 1823-1827. 10.1038/sj.bjc.6603821.CrossRefPubMedPubMedCentral
11.
go back to reference Tougeron D, Di Fiore F, Thureau S, Berbera N, Iwanicki-Caron I, Hamidou H, Paillot B, Michel P: Definitive chemoradiotherapy in elderly patients with an oesophageal cancer: A good alternative treatment in inoperable or locally advanced cancer. Br J Cancer. 2008, 99: 1586-92. 10.1038/sj.bjc.6604749.CrossRefPubMedPubMedCentral Tougeron D, Di Fiore F, Thureau S, Berbera N, Iwanicki-Caron I, Hamidou H, Paillot B, Michel P: Definitive chemoradiotherapy in elderly patients with an oesophageal cancer: A good alternative treatment in inoperable or locally advanced cancer. Br J Cancer. 2008, 99: 1586-92. 10.1038/sj.bjc.6604749.CrossRefPubMedPubMedCentral
13.
go back to reference Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG: Morbidity during hospitalization: can we predict it?. J Chron Dis. 1997, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRef Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG: Morbidity during hospitalization: can we predict it?. J Chron Dis. 1997, 40: 373-383. 10.1016/0021-9681(87)90171-8.CrossRef
14.
go back to reference Ell C, May A, Gossner L, Pech O, Günter E, Mayer G, Henrich R, Vieth M, Müller H, Seitz G, Stolte M: Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterology. 2000, 118: 670-7. 10.1016/S0016-5085(00)70136-3.CrossRefPubMed Ell C, May A, Gossner L, Pech O, Günter E, Mayer G, Henrich R, Vieth M, Müller H, Seitz G, Stolte M: Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus. Gastroenterology. 2000, 118: 670-7. 10.1016/S0016-5085(00)70136-3.CrossRefPubMed
15.
go back to reference Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992, 326: 1593-98. 10.1056/NEJM199206113262403.CrossRefPubMed Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B: Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992, 326: 1593-98. 10.1056/NEJM199206113262403.CrossRefPubMed
16.
go back to reference Michel P, Adenis A, Di Fiore F, Boucher E, Galais MP, Dahan L, Mirabel X, Hamidou H, Raoul JL, Jacob JH, Hellot MF, Prod'homme S, Paillot B: Induction cisplatin-irinotecan followed by concurrent cisplatin-irinotecan and radiotherapy without surgery in oesophageal cancer: multicenter phase II FFCD trial. Br J Cancer. 2006, 95: 705-709. 10.1038/sj.bjc.6603328.CrossRefPubMedPubMedCentral Michel P, Adenis A, Di Fiore F, Boucher E, Galais MP, Dahan L, Mirabel X, Hamidou H, Raoul JL, Jacob JH, Hellot MF, Prod'homme S, Paillot B: Induction cisplatin-irinotecan followed by concurrent cisplatin-irinotecan and radiotherapy without surgery in oesophageal cancer: multicenter phase II FFCD trial. Br J Cancer. 2006, 95: 705-709. 10.1038/sj.bjc.6603328.CrossRefPubMedPubMedCentral
19.
go back to reference Sibille A, Lambert R, Souquet JC, Sabben G, Descos F: Long-term survival after photodynamic therapy for esophageal cancer. Gastroenterology. 1995, 108: 337-44. 10.1016/0016-5085(95)90058-6.CrossRefPubMed Sibille A, Lambert R, Souquet JC, Sabben G, Descos F: Long-term survival after photodynamic therapy for esophageal cancer. Gastroenterology. 1995, 108: 337-44. 10.1016/0016-5085(95)90058-6.CrossRefPubMed
20.
go back to reference Sabel MS, Smith JL, Nava HR, Mollen K, Douglass HO, Gibbs JF: Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol. 2002, 9: 210-4. 10.1007/BF02557376.CrossRefPubMed Sabel MS, Smith JL, Nava HR, Mollen K, Douglass HO, Gibbs JF: Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol. 2002, 9: 210-4. 10.1007/BF02557376.CrossRefPubMed
21.
go back to reference Gockel I, Sultanov FS, Domeyer M, Goenner U, Junginger T: Developments in esophageal surgery for adenocarcinoma: a comparison of two decades. BMC Cancer. 2007, 7: 114-10.1186/1471-2407-7-114.CrossRefPubMedPubMedCentral Gockel I, Sultanov FS, Domeyer M, Goenner U, Junginger T: Developments in esophageal surgery for adenocarcinoma: a comparison of two decades. BMC Cancer. 2007, 7: 114-10.1186/1471-2407-7-114.CrossRefPubMedPubMedCentral
22.
go back to reference Internullo E, Moons J, Nafteux P, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Lerut T: Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg. 2008, 33: 1096-104. 10.1016/j.ejcts.2008.03.004.CrossRefPubMed Internullo E, Moons J, Nafteux P, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Lerut T: Outcome after esophagectomy for cancer of the esophagus and GEJ in patients aged over 75 years. Eur J Cardiothorac Surg. 2008, 33: 1096-104. 10.1016/j.ejcts.2008.03.004.CrossRefPubMed
23.
go back to reference Bleiberg H, Conroy T, Paillot B, Lacave AJ, Blijham G, Jacob JH, Bedenne L, Namer M, De Besi P, Gay F, Collette L, Sahmoud T: Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer. 1997, 33: 1216-20. 10.1016/S0959-8049(97)00088-9.CrossRefPubMed Bleiberg H, Conroy T, Paillot B, Lacave AJ, Blijham G, Jacob JH, Bedenne L, Namer M, De Besi P, Gay F, Collette L, Sahmoud T: Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer. 1997, 33: 1216-20. 10.1016/S0959-8049(97)00088-9.CrossRefPubMed
24.
go back to reference Trumper M, Ross PJ, Cunningham D, Norman AR, Hawkins R, Seymour M, Harper P, Iveson T, Nicolson M, Hickish T: Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophago-gastric cancer: A pooled analysis of three clinical trials. Eur J Cancer. 2006, 42: 827-34. 10.1016/j.ejca.2005.08.044.CrossRefPubMed Trumper M, Ross PJ, Cunningham D, Norman AR, Hawkins R, Seymour M, Harper P, Iveson T, Nicolson M, Hickish T: Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophago-gastric cancer: A pooled analysis of three clinical trials. Eur J Cancer. 2006, 42: 827-34. 10.1016/j.ejca.2005.08.044.CrossRefPubMed
25.
go back to reference Polee MB, Hop WC, Kok TC, Eskens FA, van der Burg ME, Splinter TA, Siersema PD, Tilanus HW, Stoter G, van der Gaast A: Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy. Br J Cancer. 2003, 89: 2045-2050. 10.1038/sj.bjc.6601364.CrossRefPubMedPubMedCentral Polee MB, Hop WC, Kok TC, Eskens FA, van der Burg ME, Splinter TA, Siersema PD, Tilanus HW, Stoter G, van der Gaast A: Prognostic factors for survival in patients with advanced oesophageal cancer treated with cisplatin-based combination chemotherapy. Br J Cancer. 2003, 89: 2045-2050. 10.1038/sj.bjc.6601364.CrossRefPubMedPubMedCentral
26.
go back to reference Di Fiore F, Lecleire S, Pop D, Rigal O, Hamidou H, Paillot B, Ducrotté P, Lerebours E, Michel P: Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol. 2007, 102: 2557-63. 10.1111/j.1572-0241.2007.01437.x.CrossRefPubMed Di Fiore F, Lecleire S, Pop D, Rigal O, Hamidou H, Paillot B, Ducrotté P, Lerebours E, Michel P: Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol. 2007, 102: 2557-63. 10.1111/j.1572-0241.2007.01437.x.CrossRefPubMed
Metadata
Title
Esophageal cancer in the elderly: an analysis of the factors associated with treatment decisions and outcomes
Authors
David Tougeron
Hadji Hamidou
Michel Scotté
Frédéric Di Fiore
Michel Antonietti
Bernard Paillot
Pierre Michel
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2010
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-10-510

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