Older Patients Fare Worse Than Young After Receiving CCRT for Esophageal Cancer

Late cardiopulmonary toxicity is greatest for patients 75 and older who receive combination chemo and radiation therapy (CCRT) for esophageal cancer, according to a study published in the March 25, 2009, Red Journal.

Madoka Morota, et al., followed 69 patients for up to 56 months after they received CCRT for Stage I-IVB esophageal cancer. The participants were treated for thoracic squamous cell cancer with 60 Gy of radiation therapy in 30 fractions over eight weeks. This included a two-week break. At the same time, the patients received two cycles of fluorouracil/cisplatin chemotherapy.

The radiation fields covered primary tumors, metastatic lymph nodes and supraclavicular, mediastinal and celiac nodes.

Over two years, the researchers assessed late radiation morbidity using the scoring of the Radiation Therapy Oncology Group/European Organization. They recorded five cardiopulmonary toxic events of Grade 3, pericarditis, or higher in four patients and Grade 5, heart failure, and Grade 3 in one patient.

Results showed a 29 percent incidence of late cardiopulmonary toxicity of Grade 3 or greater for patients 75 or older. Younger patients experienced only 3 percent. The researchers concluded that the CCRT used in the study, “with an extensive radiation field is acceptable for younger patients, but is not tolerated by patients older than 75 years.”

This study can be accessed at www.redjournal.org, the site of the International Journal of Radiation Oncology * Biology * Physics.