Toxicity and outcomes after chemoradiation for esophageal cancer in patients age 75 or older

Randomized trials of chemoradiation for esophageal cancer have included very few patients age ≥ 75. In this retrospective study, we describe the outcomes and toxicity of full‐dose chemoradiation in elderly patients with esophageal cancer. Patients, age ≥ 75, treated with full‐dose chemoradiation for esophageal carcinoma from 2002 to 2008 were retrospectively reviewed. Thirty‐four patients were identified with a median age of 79.5 (range 75–89). The median Eastern Cooperative Oncology Group performance status was 1 (range 0–3) and the median Adult Comorbidity Evaluation‐27 score was 1 (range 0–3). Twenty‐eight patients received definitive and six received neoadjuvant chemoradiation. The median radiation dose delivered was 50.4 Gray (range 3.6–68.4 Gray). Platinum‐based chemotherapy was used in 79.4% of patients. Fifty percent of the patients completed all planned radiation therapy (RT) and chemotherapy; 85.3% completed RT. Acute toxicity ≥ grade 4 occurred in 38.2% of patients, and 70.6% of the patients required hospitalization, emergency department visit, and/or RT break. Median follow‐up was 14.5 months among 7 survivors, and median survival was 12.0 months (95% confidence interval [CI]: 9.7 to 24.1 months). The actuarial overall survival at 2 years was 29.7% (95% CI: 16.6 to 52.6%). There were four treatment‐related deaths. The median time to any recurrence was 10.4 months. Nineteen patients had a local and/or distant recurrence. In conclusion, elderly patients experienced substantial morbidity from chemoradiation, and long‐term survival was low. Future efforts to improve treatment tolerability in the elderly are needed.