Evaluating the Impact of Age and G8 Assessment on Definitive Treatment Strategies in Elderly Patients with Local Advanced Esophageal Carcinoma.

IF 2 4区 医学 Q3 ONCOLOGY Oncology Research and Treatment Pub Date : 2024-10-16 DOI:10.1159/000542017
Berna Akkus Yildirim, Sedef Gokhan Acikgoz, Mustafa Halil Akboru, Emre Uysal, Baver Tütün, Necla Gurdal, Yilmaz Tezcan
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Abstract

Introduction: While chemoradiotherapy (CRT) is commonly employed as a curative approach for esophageal cancer, administering standard CRT to elderly patients often presents challenges in practical settings. The objective of this study was to compare treatment tolerance and survival outcomes between younger and elderly patients (aged ≥65 years) diagnosed with locally advanced esophageal cancer receiving curative-intent treatment. Additionally, it aimed to assess the impact of the Geriatric-8 Health Status Screening Tool (G8 score) on treatment decisions in elderly patients.

Methods: Ninety-seven patients treated with neoadjuvant or definitive CRT for locally advanced esophageal cancer were retrospectively evaluated at two centers from 2013 to 2023. We divided the patients by age (<65 and ≥65 years) and assessed their demographic, clinical, and treatment data, including pre- and post-treatment G8 scores. Radiotherapy (RT) was administered at a median dose of 50.4 Gy (45-66 Gy). Planned concurrent chemotherapy was completed in 73 (75.3%) of the patients.

Results: In the comparative study of 97 esophageal cancer patients, 48 geriatric (aged ≥65 years) and 49 younger individuals were followed up for a median of 20 and 21 months, respectively. No significant statistical differences were noted between the groups concerning baseline and treatment characteristics. Surgical intervention rates were comparable, with 22.9% of geriatric and 36.7% of young patients undergoing surgery (p = 0.184). There were no significant differences in pathological complete response, local recurrence, distant metastasis, progression, or death rates. The median progression-free survival (PFS) for geriatric and younger patients was 31 months (95% CI, 13.6-48.4) and 19 months (95% CI, 0-39.4), respectively (p = 0.832). The median overall survival (OS) was 38 months (95% CI, 23.8-52.2) in geriatric patients, while it was not reached in younger patients (p = 0.745). There was no significant difference between the two groups. The pretreatment and post-treatment G8 values of the geriatric patients were 9.25 (6-13.5) and 9.5 (6-14), respectively. Patients with increased G8 scores were found to have significantly higher PFS (median 85 months vs. 11 months, p = 0.001) and OS (median 85 months vs. 14 months, p = 0.001) compared to those with unchanged or decreased G8 scores.

Conclusion: Age alone should not be the determining factor in the treatment decision of elderly patients diagnosed with locally advanced esophageal cancer. Moreover, CRT could be safely performed even in patients with low G8 scores, and although the G8 score may not directly influence treatment decision, its enhancement during the treatment process holds significant prognostic value.

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评估年龄和 G8 评估对局部晚期食管癌老年患者确定性治疗策略的影响
简介:虽然化放疗(CRT)通常被用作食管癌的根治方法,但在实际环境中,对老年患者实施标准的 CRT 常常会遇到挑战。本研究的目的是比较年轻患者和老年患者(年龄≥65 岁)的治疗耐受性和生存结果。此外,该研究还旨在评估老年8项健康状况筛查工具(G8评分)对老年患者治疗决策的影响:回顾性评估了2013年至2023年期间在两个中心接受新辅助或最终CRT治疗的97例局部晚期食管癌患者。我们将患者按年龄划分(65岁和≥65岁),评估了他们的人口统计学、临床和治疗数据,包括治疗前后的G8评分。放疗(RT)的中位剂量为 50.4 Gy(45-66 Gy)。73名患者(75.3%)完成了计划中的同期化疗:在对 97 名食管癌患者进行的比较研究中,48 名老年患者(年龄≥65 岁)和 49 名年轻患者分别接受了中位数为 20 个月和 21 个月的随访。两组患者的基线和治疗特征无明显统计学差异。手术干预率相当,22.9% 的老年患者和 36.7% 的年轻患者接受了手术(P=0.184)。病理完全反应率、局部复发率、远处转移率、病情进展率和死亡率均无明显差异。老年患者和年轻患者的中位无进展生存期(PFS)分别为31个月(95% CI,13.6-48.4)和19个月(95% CI,0-39.4)(P=0.832)。老年患者的中位总生存期(OS)为38个月(95% CI,23.8-52.2),而年轻患者未达到这一目标(P=0.745)。两组之间无明显差异。老年患者治疗前和治疗后的 G8 值分别为 9.25(6-13.5)和 9.5(6-14)。与G8评分不变或降低的患者相比,G8评分升高的患者的PFS(中位85个月对11个月,P=0.001)和OS(中位85个月对14个月,P=0.001)明显更高:结论:对于确诊为局部晚期食管癌的老年患者,年龄不应成为决定治疗方案的唯一因素。此外,即使 G8 评分较低的患者也可以安全地进行 CRT,虽然 G8 评分可能不会直接影响治疗决策,但其在治疗过程中的提高对预后具有重要价值。
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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
84
期刊介绍: With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
期刊最新文献
Evaluating the Impact of Age and G8 Assessment on Definitive Treatment Strategies in Elderly Patients with Local Advanced Esophageal Carcinoma. A Comprehensive Review of Epidermal Growth Factor Receptor Mutation Abundance in Non-Small Cell Lung Cancer Treated with Tyrosine Kinase Inhibitors. EGFR plus MET targeted therapies for overcoming treatment resistance in EGFR mutant NSCLC. A Case Report. EGFR-TKI combined with radiotherapy in 105 patients of lung adenocarcinoma with brain metastasis: a retrospective study of prognostic factors analysis. Guidelines: onkopedia - what´s new? Locally advanced rectal cancer.
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