Targeting therapy for esophageal cancer in patients aged 70 and over
Targeting therapy for esophageal cancer in patients aged 70 and over
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DOI：
10.1016/j.jgo.2012.12.006
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发表时间：
2013-04-01
影响因子：
3
通讯作者：
Walsh, Thomas N.
中科院分区：
文献类型：
--
作者：
Furlong, Heidi;Bass, Gary;Walsh, Thomas N.
背景：虽然癌症是老年人的疾病，但这些患者在随机试验中的代表性不足。老年人食管癌的治疗具有挑战性，因为手术相关的发病率和死亡率。目的：我们在70岁及以上的癌症患者中研究了新辅助化疗-放疗（naCRT）策略，随后进行手术或监测。方法：一个前瞻性累积数据库在90个月的时间内确定了56名连续患者，年龄在70岁及以上，患有食管癌并接受新辅助CRT（naCRT）+/-手术治疗。结果：在129例合格患者中，66例（51%）接受了姑息治疗，63例（49%）接受了治疗干预，即7例接受手术，56例在bar手术下接受naCRT（+/-）。在这56例患者中，33例（59%）为腺癌（AC），23例（41%）为鳞状细胞癌（SCC）。25例（45%）有完全临床缓解（cCR），其中6例立即切除; 4例（67%）有完全病理学缓解（pCR）; 19例cCR患者下降或不适合手术并接受监测;其中3例进行了间隔食管切除术; 16例未提供或拒绝切除。8例（50%）存活>= 3年。整个队列的平均总生存期为28个月; cCR为47个月;接受初次切除术的患者为61个月，未接受切除术的cCR为46个月，因复发疾病接受间隔切除术的患者为29个月。在cCR中，手术并没有提供生存优势（p=0.861）。结论：cCR产生的总3年生存率为50%，无需手术。由于45%的患者具有cCR至naCRT，因此在高风险cCR患者中强制性切除几乎没有意义。由于在复发性疾病中可以选择挽救性食管切除术，这种选择性策略对于老年癌症患者是一种有吸引力的选择。(C)2012爱思唯尔有限公司保留所有权利。
Background: While cancer is a disease of the elderly, these patients are under-represented in randomized trials. Esophageal cancer-management in the elderly is challenging because of the morbidity and mortality associated with surgery.Objectives: We examined a strategy of neo-adjuvant chemo-radiotherapy (naCRT), followed by surgery or surveillance, in selected patients with cancer aged 70 and older.Methods: A prospectively-accrued database identified 56 consecutive patients over a 90-month period, who were aged 70 years and over, presented with esophageal carcinoma and were treated with neo-adjuvant CRT (naCRT)+/- surgery.Results: Of 129 eligible patients, 66 (51%) received palliative measures, while 63 (49%) had curative intervention, namely 7 had surgery and 56 had naCRT (+/-) under bar surgery. Of these 56 patients, 33 (59%) had adenocarcinoma (AC) and 23 (41%) had squamous cell carcinoma (SCC). Twenty-five (45%) had a complete clinical response (cCR), of which 6 had immediate resection; 4 (67%) had a complete pathological response (pCR); 19 patients with a cCR declined or were unfit for surgery and underwent surveillance; of these, 3 had interval esophagectomy; 16 were not offered or declined resection. Eight (50%) have survived >= 3 years. Mean overall survival was 28 months for the entire cohort; 47 months for cCRs; 61 months for patients undergoing primary resection, 46 months for cCRs who did not undergo resection and 29 months for those undergoing interval resection for recurrent disease. In cCRs, surgery did not provide a survival advantage (p=0.861).Conclusion: cCR yields an overall 3-year survival of 50% without operation. As 45% of patients have a cCR to naCRT, obligatory resection in high-risk cCR patients makes little sense. With the option for salvage esophagectomy in re-emergent disease, this selective strategy is an attractive alternative for elderly patients with cancer. (C) 2012 Elsevier Ltd. All rights reserved.