Nav: Home

Treatment improved overall survival in elderly patients with early-stage esophageal cancer

April 27, 2017

DENVER - Elderly patients with early-stage esophageal cancer that received treatment had an increased 5-year overall survival when compared to patients who received observation with no treatment.

Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death related to cancer. In the United States, there are over 16,000 people diagnosed with the disease annually with an even higher prevalence in other parts of the world. The National Comprehensive Cancer Network (NCCN) guidelines suggest surgery as the standard treatment for stage I esophageal cancer. Despite these guidelines, various factors prevent a patient from being managed surgically such as age of the patient, multiple comorbidities and differences in sociodemographic and socioeconomic status. The median age of patients diagnosed with esophageal cancer is around 67 years with a 5-year overall survival (OS) rate of 18.8%. Age often drives treatment decisions of elderly patients (? 80 years of age) representing a unique and challenging subpopulation to health care providers. Randomized clinical trials have shown that survival of patients with esophageal cancer correlates with the degree of treatment intensity they receive. However less aggressive, nonsurgical therapy such as chemoradiation is commonly provided to elderly patients even with early-stage disease.

A group of researchers in the United States conducted a retrospective study to evaluate the practice patterns and outcomes of elderly patients (? 80 years of age) with stage I esophageal cancer who received four different types of treatment: esophagectomy (Eso), local excision (LE), chemoradiotherapy (CRT) and observation (Obs). The National Cancer Data Base (NCDB) was queried for patients ? 80 years of age diagnosed with cT1-T2 N0 esophageal cancer from 2004 to 2012. Patients meeting the criteria were divided into four groups: Eso, LE, CRT, and Obs. Patient, tumor, and treatment parameters were extracted and compared. Analyses were performed on OS and postoperative 30- and 90-day mortality.

The results of the study were published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC). From the NCDB query, 923 patients were identified and analyzed. Of these, 43% were observed, 22% underwent CRT, 25% had LE and 10% had Eso. The median age was 84 years (range 80-90) for the overall cohort and lower in the Eso group compared to Obs (82 years vs. 85 years, p<0.001). Patients were predominantly male and Caucasian; however, the highest proportion of females and African Americans were found in the nonsurgical groups (Obs or CRT; p<0.001). Patients undergoing Obs were older, had more comorbidities, were treated at non-academic centers and lived ? 25 miles from the facility. Patients receiving surgery (Eso/LE) were more commonly younger, male, Caucasian and in the top income quartile. Five-year OS was 7% for Obs, 20% for CRT, 33% for LE and 45% for Eso. Postoperative 30-day mortality between the LE and Eso groups was 1.3% and 9.6% (p<0.001), which increased to 2.6% and 20.2% at 90 days. Multivariate analysis showed improved OS for all treatments when compared to Obs: CRT (HR: 0.42, 95% CI [0.34 - 0.52], p<0.001), LE (HR: 0.30, CI [0.24-0.38], p<0.001), Eso (HR: 0.32, CI [0.23-0.44], p<0.001).

The authors comment that, "In general, health disparities were observed in this study, which are important to characterize. When stratifying the elderly by any surgery vs. CRT/Obs, female patients, African Americans and patients of lower income quartile were less likely to undergo surgery - findings that corroborate the results from other retrospective studies in non-elderly cohorts. Another key factor that drives the treatment of choice and subsequent outcome is the type of treating facility. Although more than half of patients were treated within the community, 82% of these patients did not undergo surgery compared to 42% of patients treated in an academic center. A rather compelling finding was that patients living closer to treating institutions tended to undergo observation. This study demonstrated that a surprisingly large proportion of patients age ? 80 years with stage I esophageal cancer remain under clinical observation after their diagnosis. Any form of local therapy, including CRT, statistically improved OS when compared to observation. Finally, if surgery is feasible then LE should be considered over CRT and Eso, given the potentially lower toxicity profile and postoperative mortality rates."
-end-
Co-authors Wayne Lewis Hofstetter and Steven Hsesheng Lin are members of IASLC.

About the IASLC

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer. Founded in 1974, the association's membership includes more than 5,000 lung cancer specialists in over 100 countries. Visit http://www.iaslc.org for more information.

Written by: Jacinta Wiens, PhD, 720-598-1941; Jacinta.Wiens@iaslc.org

Media Contact: Becky Bunn, 720-254-9509; Becky.Bunn@iaslc.org

International Association for the Study of Lung Cancer

Related Cancer Articles:

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.
More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.
New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.
American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.
Oncotarget: Cancer pioneer employs physics to approach cancer in last research article
In the cover article of Tuesday's issue of Oncotarget, James Frost, MD, PhD, Kenneth Pienta, MD, and the late Donald Coffey, Ph.D., use a theory of physical and biophysical symmetry to derive a new conceptualization of cancer.
Health indicators for newborns of breast cancer survivors may vary by cancer type
In a study published in the International Journal of Cancer, researchers from the UNC Lineberger Comprehensive Cancer Center analyzed health indicators for children born to young breast cancer survivors in North Carolina.
Few women with history of breast cancer and ovarian cancer take a recommended genetic test
More than 80 percent of women living with a history of breast or ovarian cancer at high-risk of having a gene mutation have never taken the test that can detect it.
Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
More Cancer News and Cancer Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Risk
Why do we revere risk-takers, even when their actions terrify us? Why are some better at taking risks than others? This hour, TED speakers explore the alluring, dangerous, and calculated sides of risk. Guests include professional rock climber Alex Honnold, economist Mariana Mazzucato, psychology researcher Kashfia Rahman, structural engineer and bridge designer Ian Firth, and risk intelligence expert Dylan Evans.
Now Playing: Science for the People

#540 Specialize? Or Generalize?
Ever been called a "jack of all trades, master of none"? The world loves to elevate specialists, people who drill deep into a single topic. Those people are great. But there's a place for generalists too, argues David Epstein. Jacks of all trades are often more successful than specialists. And he's got science to back it up. We talk with Epstein about his latest book, "Range: Why Generalists Triumph in a Specialized World".
Now Playing: Radiolab

Dolly Parton's America: Neon Moss
Today on Radiolab, we're bringing you the fourth episode of Jad's special series, Dolly Parton's America. In this episode, Jad goes back up the mountain to visit Dolly's actual Tennessee mountain home, where she tells stories about her first trips out of the holler. Back on the mountaintop, standing under the rain by the Little Pigeon River, the trip triggers memories of Jad's first visit to his father's childhood home, and opens the gateway to dizzying stories of music and migration. Support Radiolab today at Radiolab.org/donate.