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Optimal Therapy for Esophageal Cancer Feasible in Fit Elderly

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FRIDAY, Feb. 26, 2021 -- Patients 70 years and older with locally advanced esophageal or esophagogastric junction (EGJ) cancer should be considered for optimal, potentially curative therapy, including neoadjuvant chemoradiotherapy and surgical resection, according to a study published online Feb. 4 in the Journal of the American College of Surgeons.

W. Peter Sawyer, M.D., from the Ochsner Clinic Foundation in New Orleans, and colleagues used data from 405 consecutive patients with esophageal or EGJ cancer (2004 through 2019) to assess the risks of multimodality therapy with curative intent, including surgical resection, in the elderly population (≥70 years of age).

The researchers found that 188 younger patients (mean age, 59 years) and 94 older patients (mean age, 74 years) received neoadjuvant chemoradiotherapy and surgical resection for stage II and higher cancer. In the older group, preoperative American Society of Anesthesiologist class and Charlson Comorbidity Index scores were significantly worse. Postoperatively, patients in the older group more often developed atrial fibrillation and urinary retention. However, the older and younger groups had similar rates for postoperative Clavien-Dindo complication severity scores of 3 or higher and perioperative mortality, as well as similar lengths of stay. The age-adjusted survival rate at five years was 44.8 percent for the older group and 39 percent for the younger group.

"Even though our results are not randomized, these findings provide a strong indication that declining to perform a surgical resection significantly reduces the likelihood of a cure for older patients who are deemed fit for the operation," a coauthor said in a statement.

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Posted: February 2021

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