By Ed Susman
SAN FRANCISCO -- January 16, 2009 -- Elderly patients who are given neoadjuvant chemoradiation prior to undergoing surgery for oesophageal cancer do not appear to have a greater morbidity risk, researchers reported here at the 6th Gastrointestinal Cancers Symposium, cosponsored by the American Gastrointestinal Association Foundation, the American Society of Clinical Oncology, the American Society for Radiation Oncology, and the Society of Surgical Oncology (ASCO-GI).
"Some studies have reported increased postoperative mortality and morbidity with administration of neoadjuvant chemoradiation, which has led to reluctance to offer this therapy to patients over 70 years of age," said Shannon Fogh, MD, Stanford University Medical Center, Stanford, California.
"However, in our retrospective review of cases we did not observe this," Dr. Fogh said at her poster presentation on January 15.
Dr. Fogh and colleagues reviewed data from 2 institutional databases and identified 260 patients who received neoadjuvant chemoradiation between 1994 and 2005. The researchers further broke that group down to 203 patients who were younger than 70 years and 57 who were 70 years or older.
"We saw a small increase in the rate of morbidity among the older patients," she said.
About 59% of the older group experienced complications after surgery compared with 50% of the younger patients. However, Dr. Fogh said the difference did not achieve statistical significance.
"In terms of perioperative mortality, these numbers were similar -- 7% of the older patients versus 5% of the younger group, which also was not significant," she explained.
"No significant differences were detected with respect to morbidity, mortality, and overall survival in patients 70 years or older who underwent induction chemoradiotherapy," she said.
Dr. Fogh said that length of hospital stay was about 17.4 days in the older patients who received neoadjuvant chemoradiation prior to surgery and 16.6 days in the younger group with similar treatment, not a significant difference.
When the researchers compared the 57 patients who had neoadjuvant therapy with 41 patients over the age of 70 who did not have neoadjuvant treatment, the length of stay in the hospital was virtually identical -- 17.4 days with preoperative chemoradiation versus 17.5 days without.
She noted there were some complications that were seen more often in the older patients who received neoadjuvant chemoradiation compared with younger patients receiving the same treatment. Respiratory failure requiring intubation occurred in 21% of older patients and 10% of the younger cohort (P = .04) and supraventricular arrhythmia occurred in 25% of the older patients and 15% of the younger patients (P = .10).
Dr. Fogh concluded, "Given the potential to improve outcomes, this treatment should not be discounted in the elderly."
There was no industry support for the study.
[Presentation title: Do Elderly Patients Experience Increased Perioperative Morbidity and Mortality When Given Neoadjuvant Chemoradiation (CRT) Prior to Esophagectomy? Abstract 103]
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