Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis.
Esophageal Cancer in Elderly Patients, Current Treatment Options and Outcomes; A Systematic Review and Pooled Analysis.
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老年食管癌患者，目前的治疗选择和结果：一项系统回顾和汇总分析。
DOI：
10.3390/cancers13092104
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发表时间：
2021-04-27
期刊：
影响因子：
5.2
通讯作者：
Piessen G
中科院分区：
文献类型：
--
作者：
Mantziari S;Teixeira Farinha H;Bouygues V;Vignal JC;Deswysen Y;Demartines N;Schäfer M;Piessen G
与最好的支持性治疗相比，任何给定的治疗都可以提高老年食管癌患者的生存率。虽然手术可能与这些患者的并发症发生率较高有关，但它也提供了最好的生存机会，特别是当与围手术期化疗或放化疗结合时。连续放化疗仍然是一种有效的和广泛使用的治疗方法，在这一人群。食管癌治疗后的生活质量似乎并没有特别损害老年患者，虽然疾病后失去自主权的风险更高。根据现有数据，仅根据年龄将老年患者排除在治疗之外是不合理的。一个全面的一般健康状况和老年评估是必要的，以提供最佳的治疗，适合个别病人。尽管食管癌在年轻患者中有增加的趋势，但它仍然是老年人的疾病，发病率在70-79岁之间达到高峰。尽管如此，老年患者仍然被排除在主要的临床试验之外，即使在疾病的可治愈阶段，他们也经常被提供次优治疗。在这篇综述中，与姑息治疗或不治疗相比，新辅助治疗、手术甚至明确的放化疗治疗对老年患者的生存有明显的益处。与年轻患者相比，老年患者的手术通常与更高的发病率和死亡率相关，并且可能使年老体弱患者的自主性丧失风险增加。连续性放化疗是提供给老年患者的主要方式，具有非常有希望的结果，特别是对于鳞状细胞癌，尽管可能会遇到更高的急性毒性。基于上述所有情况，尽管最好的证据来自回顾性研究，但仅根据年龄而不对老年患者进行治疗是不合理的。彻底的评估和适应性治疗计划以及纳入老年患者正在进行的临床试验将允许更好地了解和管理食管癌在这个异质性和往往脆弱的人群。
Any given treatment may provide improve survival for elderly patients with oesophageal cancer compared to best supportive care. Although surgery may be related to a higher rate of complications in these patients, it also offers the best chance for survival, especially when combined with perioperative chemo-or chemoradiation. Definitive chemoradiation remains also a valid and widely used curative approach in this population. Quality of life after oesophageal cancer treatment does not seem to be particularly compromised in elderly patients, although the risk of loss of autonomy after the disease is higher. Based on the available data, excluding a priori elderly patients from curative treatment based on age alone cannot be supported. A thorough general health status and geriatric assessment is necessary to offer the optimal treatment, tailored to the individual patient. Esophageal cancer, despite its tendency to increase among younger patients, remains a disease of the elderly, with the peak incidence between 70–79 years. In spite of that, elderly patients are still excluded from major clinical trials and they are frequently offered suboptimal treatment even for curable stages of the disease. In this review, a clear survival benefit is demonstrated for elderly patients treated with neoadjuvant treatment, surgery, and even definitive chemoradiation compared to palliative or no treatment. Surgery in elderly patients is often associated with higher morbidity and mortality compared to younger patients and may put older frail patients at increased risk of autonomy loss. Definitive chemoradiation is the predominant modality offered to elderly patients, with very promising results especially for squamous cell cancer, although higher rates of acute toxicity might be encountered. Based on the all the above, and although the best available evidence comes from retrospective studies, it is not justified to refrain from curative treatment for elderly patients based on their age alone. Thorough assessment and an adapted treatment plan as well as inclusion of elderly patients in ongoing clinical trials will allow better understanding and management of esophageal cancer in this heterogeneous and often frail population.
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DOI：
10.1016/j.ijrobp.2010.04.055
发表时间：
2011-08-01
影响因子：
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作者：
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