Randomized Controlled Trial
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2014; 20(36): 13185-13190
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13185
Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma
Jian He, Zhao-Chong Zeng, Shi-Ming Shi, Ping Yang
Jian He, Zhao-Chong Zeng, Shi-Ming Shi, Ping Yang, Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: He J and Zeng ZC designed and performed the research; Yang P contributed new reagents and analytic tools; He J analyzed the data; He J, Zeng ZC, Shi SM and Yang P wrote the paper.
Supported by The Ministry of Civil Affairs of the China, No. 2008 47-2-53
Correspondence to: Zhao-Chong Zeng, MD, PhD, Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Handan Rd 220, Shanghai 200032, China. zeng.zhaochong@zs-hospital.sh.cn
Telephone: +86-21-64041990-3699 Fax: +86-21-64041990
Received: May 22, 2014
Revised: July 2, 2014
Accepted: July 24, 2014
Published online: September 28, 2014
Processing time: 132 Days and 7.6 Hours
Abstract

AIM: To investigate the clinical features and prognoses of elderly patients with esophageal carcinoma and to compare the effects of radiotherapy and rates of treatment-related pneumonitis (TRP) between elderly and non-elderly patients.

METHODS: A total of 236 patients with esophageal carcinoma who received radiotherapy between 2002 and 2012 were enrolled. The patients were divided into two groups: an elderly group (age ≥ 65 years) and a non-elderly group (age < 65 years). The tumor position and stage, lymph node and distant metastases, and incidence and severity of TRP were compared. Multivariate analysis was applied to identify independent prognostic factors.

RESULTS: The median overall survival times after radiotherapy in the elderly and non-elderly groups were 18.5 and 20.5 mo, respectively. Cox regression analysis showed that TRP grade and tumor-node-metastasis (TNM) stage were independent prognostic factors in the elderly group. High-dose radiotherapy (> 60 Gy) was associated with a high incidence of TRP. Tumor TNM staging was significantly different between the two groups in which TRP occurred. Multivariate analysis showed that TNM stage was an independent prognostic factor. Esophageal carcinoma in elderly patients was relatively less malignant compared with that in non-elderly patients.

CONCLUSION: An appropriate dose should be used to decrease the incidence of TRP in radiotherapy, and intensity modulated radiation therapy should be selected if possible.

Keywords: Esophageal carcinoma; Radiation therapy; Elderly patients; Treatment-related pneumonitis; Survival rate

Core tip: We found that the tumor characteristics of esophageal cancer in elderly patients were relatively less malignant compared with those in non-elderly patients. The incidence of lymph node and distant metastases, and recurrence or metastasis after radiotherapy were lower. The incidence of treatment-related pneumonitis was much higher in the elderly patients. A proper radiation dose could improve the curative effect and decrease the incidence of treatment-related pneumonitis in elderly patients.