Journal Article


Thomas N Walsh
Eamonn Leen
Brian O'Neill
Oscar Breathnach
Gary Bass
Heidi Furlong


Medicine & Nursing

neoadjuvant therapy pathology cohort studies kaplan meier estimate male watchful waiting esophagectomy aged follow up studies carcinoma squamous cell aged 80 and over therapy esophageal neoplasms mortality humans lymphatic metastasis palliative care adenocarcinoma female chemoradiotherapy statistics numerical data

Targeting therapy for esophageal cancer in patients aged 70 and over. (2012)

Abstract While cancer is a disease of the elderly, these patients are under-represented in randomized trials. Esophageal cancer-management in the elderly is challenging because of the morbidity and mortality associated with surgery. We examined a strategy of neo-adjuvant chemo-radiotherapy (naCRT), followed by surgery or surveillance, in selected patients with cancer aged 70 and older. A prospectively-accrued database identified 56 consecutive patients over a 90-month period, who were aged 70years and over, presented with esophageal carcinoma and were treated with neo-adjuvant CRT (naCRT)±surgery. Of 129 eligible patients, 66 (51%) received palliative measures, while 63 (49%) had curative intervention, namely 7 had surgery and 56 had naCRT±surgery. Of these 56 patients, 33 (59%) had adenocarcinoma (AC) and 23 (41%) had squamous cell carcinoma (SCC). Twenty-five (45%) had a complete clinical response (cCR), of which 6 had immediate resection; 4 (67%) had a complete pathological response (pCR); 19 patients with a cCR declined or were unfit for surgery and underwent surveillance; of these, 3 had interval esophagectomy; 16 were not offered or declined resection. Eight (50%) have survived ≥3years. Mean overall survival was 28months for the entire cohort; 47months for cCRs; 61months for patients undergoing primary resection, 46months for cCRs who did not undergo resection and 29months for those undergoing interval resection for recurrent disease. In cCRs, surgery did not provide a survival advantage (p=0.861). cCR yields an overall 3-year survival of 50% without operation. As 45% of patients have a cCR to naCRT, obligatory resection in high-risk cCR patients makes little sense. With the option for salvage esophagectomy in re-emergent disease, this selective strategy is an attractive alternative for elderly patients with cancer.
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Full list of authors on original publication

Thomas N Walsh, Eamonn Leen, Brian O'Neill, Oscar Breathnach, Gary Bass, Heidi Furlong

Experts in our system

T N Walsh
IT Blanchardstown
Total Publications: 53
Gary A Bass
IT Blanchardstown
Total Publications: 8