Outcomes from a single institution cohort of 248 patients with stage I–III esophageal cancer treated with radiotherapy: Comparison of younger and older populations

Highlights

• •

  Similar outcomes in older and younger populations, with best in trimodality patients.

• •

  Patients planned with IMRT had significantly lower heart V30Gy doses.

• •

  Best survival was seen in non-surgical older patients with a heart V30Gy under 46 %.

Abstract

Outcomes for patients receiving radiotherapy (RT) for non-metastatic esophageal cancer at a single institution were assessed, as well as the impact of factors including age and intensity modulated RT (IMRT) planning on patient outcomes. A retrospective cohort of patients treated with RT for stage I-III esophageal cancer between 2010 and 2018 was identified. Among 248 identified patients, 28 % identified as older (≥75 years of age). Other than histology, there were no other statistically significant differences in patient and tumour characteristics between the younger and older populations. Treatments varied between the two age groups, with significantly less older patients completing trimodality treatments (17 % vs 58 %). Median overall survival (M−OS) and progression-free survival (M−PFS) were 20 months and 12 months for all patients and 40 months and 26 months for trimodality patients, respectively. In the older patients, the M−OS improved from 13 months for all to 34 months for trimodality patients; and M−PFS from 10 months to 16 months. On multivariate analysis, the use of trimodality therapy showed improved OS (HR 0.26, p < 0.001). In the non-surgical older patient group, significantly better survival was seen in patients who had a heart V30Gy under 46 %. There was no significant difference in M−OS in patients planned with IMRT compared with 3D-conformal RT. Clinical outcomes in the treatment of esophageal cancer vary significantly by treatment approach, with the most favourable results in those receiving trimodality therapy. Among older patients deemed fit after assessment by the multidisciplinary team for trimodality treatments, the M−OS is comparable to the younger patient group.