| PART1Postoperative Radiotherapy for the young-old Patients with Stage II/III Thoracic Esophageal Squamous Cell Carcinoma(age between 65 and 75)Background:This study aimed to retrospectively analyze the efficacy and safety of esophagectomy and postoperative radiotherapy(PORT)for patients with thoracic esophageal squamous cell carcinoma(TESCC)in the young-old(age between 65and 75 years).Methods:The clinical data of 68 young-old patients with TESCC who underwent esophagectomy and PORT from May 2004 to May 2018 in People's Liberation Army(PLA)81 Hospital were analyzed.Most patients showed locally advanced disease(T3/4:82.3%,N+:54.6%,stage III:58.9%).The Kaplan–Meier method was used to calculate overall survival(OS),disease-free survival(DFS),local recurrence-free survival(LRFS),and distant metastasis-free survival(DMFS).The log-rank method was used to test the differences.Multivariate analysis was conducted using the Cox model.Results:The follow-up rate was 98.5%,and the median follow-up time was 27.73months.The whole 1-,3-,and 5-year OS rates were 87.9%,65.2%,and 50.4%,respectively,and the median OS was 61.2 months.The median DFS,LRFS and DMFS were 48.77,54.43 and 60.47 months,respectively.Postoperative T staging(c~2=6.346;P=0.012),lymph node metastasis(c~2=4.916;P=0.027),number of lymph node metastasis(c~2=5.562;P=0.018),postoperative staging(c~2=10.431;P=0.001)were the main factors affecting prognosis.Postoperative staging(HR:3.626,95%CI,1.610-8.167;P=0.002)was independent prognostic factors in multivariate analysis.Little severe toxicity was observed.Conclusions:In elderly patients with TESCC who can tolerate surgery,PORT is safe and can be tolerated.Postoperative staging is an independent prognostic factor for postoperative esophageal cancer in the elderly.The survival rate of patients with stage II is significantly higher than that of stage III patients.Lymphatic metastasis,number of lymph node metastasis,T stage,intraoperative tumor Invasion can affect prognosis,but it is not an independent prognostic factor affecting survival.Compared with 3DCRT,IMRT does not improve survival for elderly patients with TESCC,but have physical advantages,so the clinical benefit requires large-scale clinical validation.CCRT in patients with TESCC did not improve survival compared with PORT alone,a prospective study was needed.This study showed that age,gender,tumor location,KPS,preoperative weight loss,eating status,and tumor cell differentiation were not associated with prognosis.It is recommended that elderly patients undergo Comprehensive Geriatric Assessment,and actively carry out anti-tumor treatment and best supportive treatment in the case of physical tolerance.PART 2Safety and efficacy of Radiotherapy± Chemothearpy for elderly patients with esophageal squamous cell cancerObjective: To evaluate the efficacy and adverse effects of radiotherapy alone or combined with chemotherapy in elderly patients with esophageal cancer.Methods: A total of 122 patients with esophageal squamous cell cancer were enrolled in the clinical study,age?65.The radiotherapy was delivered at a total dose of 50~70Gy(1.8~2.0Gy per fraction).41 patients received concurrent chemotherapy,81 received radiotherapy alone.Overall survival(0S)rates were determined using the Kaplan-Meier method,and survival difference analysis and univariate prognostic analysis was performed using the log-rank test.Multivariate prognostic analyses were performed using the Cox proportional hazard model.Results: The follow up rate was 98%.The median overall survival of all patients were 24.4m.The 1-2-and 3-year overall survival rates of all patients were 70.5%?52.3%?35.3%.The median overall survival of DRT were 23.4m,1-,2-and 3-year OS were 69.0%?48.8%?33.7%.The median overall survival of CCRT were 27.1m.The 1-2-and 3-year OS were 73.0%?59.1%?38.6%,and there are not significantly different between RT and CCRT(P=0.228).Univariate analysis indicated that KPS,T stage,N stage,clinical stage,radiotherapy dose were prognostic factor for OS.Multivariate analyses showed that KPS,T stage,N stage were independent predictors for OS.Acute and late toxicities were mild or moderate.No grade IV toxicities were observed.Conclusions: DRT for ESCC in the elderly is safe and the side effects can be tolerated.Univariate analysis showed that KPS score,clinical T stage,N stage,clinical stage and radiotherapy dose were the main factors affecting prognosis.Multivariate analysis showed that KPS,T stage and N stage were independent factors affecting prognosis.CCRT did not improve the survival of esophageal cancer in the elderly,but due to the small number of cases and many confounding factors,further research is needed.In elderly patients with ESCC undergoing DRT,if the dose of radiotherapy increased to 60~66Gy,the patient's tolerance is still good,which can prolong survival and need further confirmation.PART3Evaluation of Surgery Plus Postoperative Radiotherapy or Definitive Radiotherapy for Elder Patients with Esophageal CancerObjective: 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).Materials 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.The majority of patients showed locally advanced disease(T3/4: 70.5%,N+: 70.5%,stage III: 51.6%).Overall survival(0S)were determined using the Kaplan-Meier method,and survival difference analysis and univariate prognostic analysis was performed using the log-rank test.Multivariate prognostic analyses were performed using the Cox proportional hazard model.Results:Compared to patients who received DRT,patients who received PORT had a lower AACCI(2.49±0.61 VS.3.73±1.28,X2=7.283,P=0.000),higher KPS(X2=9.016,P=0.003)and were of a younger age(68.90±3.00 VS.75.17±5.71,X2=9.925,P=0.000).Median follow-up period was 19.22 months(1–133).Overall survival(OS)was significantly higher in the PORT group(median,61.2 months;95% CI,46.04-76.36)compared to the DRT group(median,24.37 months;95% CI,15.43-33.31).By univariate analysis,treatment method(HR: 2.47,95% CI,1.56-3.91;P=0.000),Clinical T stage(HR: 0.57,95% CI,0.35-0.92;P=0.021),lymph node metastasis(HR: 0.43,95% CI,0.28-0.69;P=0.000),and clinical TNM stage(HR: 0.54,95% CI,0.36-0.80;P=0.002)were the major factors that affected prognosis.Multivariate analysis showed that treatment method(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.For subgroup analysis,overall survival in patients receiving PORT was significantly higher compared to patients in the DRT group in the T3-4 group(HR: 2.98,95% CI,1.80-4.92;P=0.000),and N+ group(HR: 2.20,95% CI,1.26-3.83;P=0.006).Conclusions: 1,For elderly patients with TESCC,PORT and DRT are safe and effective,and side effects can be tolerated.2,PORT group is better than DRT in survival,the addition of synchronous chemotherapy did not improve survival.T1-2 patients survived better than T3-4 patients;compared with patients with lymph node metastasis,no lymph node metastasis has a survival advantage;clinical stage can better guide the prognosis,and the survival rate of patients with stage I-II is significantly higher than that of stage III patient.3,prognosis analysis: treatment,T staging and lymph node metastasis are independent factors affecting the survival of esophageal cancer in the elderly.Age,gender,AACCI,and the presence or absence of concurrent chemotherapy were not major factors influencing prognosis.4,stratified analysis showed that at age ?70 years old,KPS > 70 points,AACCI ? 3 points,T3-4 or N+ subgroup,PORT survival was significantly better than DRT.There was no significant difference in PORT and DRT between patients with age >70 years,AACCI > 3 points,T1-2,or no lymph node metastasis.5,for elderly patients with better physical condition can accept the more positive treatments same as younger patients,such as surgery + PORT.Considering the AACCI,KPS and age,DRT remains the main treatment of choice for elderly patients with TESCC,especially for those >75 years of age. |
PDF Full Text Request