Age should not prevent Aggressive Esophageal Cancer Treatmen
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Neoadjuvant chemoradiation plus esophagectomy can be performed safely in well-selected older patients with locally advanced esophageal or esophagogastric junction cancer, according to a review of 282 patients.

To understand the risk of multimodality curative therapy, including surgical resection in the elderly population, doctors studied their experience with curative therapy in this patient population and compared the risks and outcomes with those in a younger population.

Four hundred and five consecutive patients with esophageal or EGJ cancer underwent primary treatment at the institution, including esophagectomy. Data collected included demographic information, tumor stage, preoperative Charlson Comorbidity Index scores, treatment variables, and short- and long-term outcomes. Patients who were 70 years or older were classified as the “older” group and patients younger than 70 years were “younger.”

One hundred and eighty-eight younger and 94 older patients received neoadjuvant chemoradiotherapy and surgical resection for stage II and higher cancer.

The review outcomes were;
--Preoperative American Society of Anesthesiologist and Charlson Comorbidity Index scores were significantly worse in the older group.

--Postoperative atrial fibrillation and urinary retention developed more often in the older group.

--Despite this, the rate of postoperative Clavien-Dindo complication severity scores of 3 or higher, perioperative mortality rates, and lengths of stay were similar.

--The long-term age-adjusted survival rate was 44.8% at 5 years for the group 70 years or older and 39% for the group younger than 70 years (NS).

In conclusion, patients 70 years and older with locally advanced esophageal or EGJ cancer should be evaluated for optimal curative therapy including neoadjuvant chemoradiotherapy and surgical resection. Although preoperative risk scoring and postoperative atrial arrhythmias are higher in the older group, short- and long-term outcomes are not inferior in these patients.

Journal of American College of Surgeons
Source: https://doi.org/10.1016/j.jamcollsurg.2020.11.027
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