Outcomes by treatment modality in elderly patients with localized gastric and esophageal cancer

A. Natori, B. A. Chan, H. W. Sim, L. Ma, D. W. Yokom, E. Chen, G. Liu, G. Darling, C. Swallow, S. Brar, J. Brierley, J. Ringash, R. Wong, J. Kim, P. Rogalla, S. Hafezi-Bakhtiari, J. Conner, J. Knox, E. Elimova, R. W. Jang

Abstract


Background We aimed to assess current treatment patterns and outcomes in elderly patients with localized gastric and esophageal (ge) cancers.

Methods This retrospective analysis considered patients 75 years of age or older with ge cancers treated during 2012–2014. Patient demographics and tumour characteristics were collected. Overall survival (os) and diseasefree survival were assessed by univariable and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors affecting treatment choices.

Results The 110 patients in the study cohort had a median age of 81 years (range: 75–99 years). Primary disease sites were esophageal (55%) and gastric (45%). Treatment received included radiation therapy alone (29%), surgery alone (26%), surgery plus perioperative therapy (14%), chemoradiation alone (10%), and supportive care alone (14%). In multivariable analyses, surgery (hazard ratio: 0.48; 95% confidence interval: 0.26 to 0.90; p = 0.02) was the only independent predictor for improved os. Patients with a good Eastern Cooperative Oncology Group performance status (p = 0.008), gastric disease site (p = 0.02), and adenocarcinoma histology (p = 0.01) were more likely to undergo surgery.

Conclusions At our institution, few patients 75 years of age and older received multimodality therapy for localized ge cancers. Outcomes were better for patients who underwent surgery than for those who did not. To ensure optimal treatment selection, comprehensive geriatric assessment should be considered for patients 75 years of age and older with localized ge cancers.


Keywords


Elderly patients; geriatric assessments; gastric cancer; esophageal cancer; treatment selection

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DOI: http://dx.doi.org/10.3747/co.25.4208






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