Prognosis of radiotherapy for esophageal cancer in elderly patients exceeding seventy-five years old

BACKGROUND Esophageal cancer(EC)often occurs in the elderly,with approximately 33%of patients aged≥75 years at the time of diagnosis.AIM To evaluate the prognostic factors for radiotherapy(RT)in elderly patients with unresectable EC.METHODS We retrospectively analyzed the clinical characteristics,toxic reactions,and survival information of EC patients aged≥75 years who underwent intensity-modulated RT at Lu’an Hospital of Anhui Medical University between January 2016 and September 2023.Kaplan-Meier analysis was used to draw the overall survival(OS)curves,and Cox regression analysis was employed to evaluate the influence of various clinical factors on the prognosis.RESULTS A total of 139 patients were enrolled.The median follow-up time was 52.0 months.The median OS was 20.0 months.The 1-year,2-year,3-year,and 5-year OS rates were 69.8%,38.7%,28.2%,and 17.5%,respectively.Univariate analysis showed that age,radiation dose,and chemotherapy had no significant impact on prognosis.Multivariate analysis indicated that clinical stage[Ⅲ-Ⅳa vsⅠ-Ⅱ,hazard ratio(HR)=2.421,95%confidence interval(CI):1.242-4.718,P=0.009;IVb vsⅠ-Ⅱ,HR=4.222,95%CI:1.888-9.438,P<0.001),Charlson comorbidity index(CCI)(0 vs≥1,HR=1.539,95%CI:1.015-2.332,P=0.042),and nutritional risk screening 2002(NRS2002)(<3 vs≥3,HR=2.491,95%CI:1.601-3.875,P<0.001)were independent prognostic factors for OS.CONCLUSION Our results suggest that CCI and NRS2002 were independent prognostic factors of OS for unresectable elderly EC patients undergoing RT.For elderly patients with EC,full attention should be given to biological age-related indicators,such as comorbidities and nutrition,when formulating treatment protocols.These factors should be considered in future clinical practice.

Clinical features, outcomes and treatment-related pneumonitis in elderly patients with esophageal carcinoma

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.

Radiotherapy combined with nimotuzumab for elderly esophageal cancer patients:A phaseⅡclinical trial

Objective:To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma(EC).Methods:Eligible patients were aged 70 years or older and had treatment-naive,histologically proven inoperable locally advanced EC.Enrolled patients received radiotherapy with a total dose of 50-60 Gy in 25-30 fractions,concurrent with weekly infusion of nimotuzumab.The primary end point was the rate of more than grade 3 toxicities.Results:From June 2011 to July 2016,46 patients with stageⅡ-IV EC with a median age of 76.5 years were enrolled.There were 10,28 and 8 patients with stageⅡ,III and IV disease,respectively.The common acute toxicities included esophagitis(grade 1-2,75.4%;grade 3,8.7%),pneumonitis(grade 1,4.3%;grade 2,6.5%;grade3,2.2%),leukopenia(grade 1-2,60.9%;grade 3-4,4.4%),gastrointestinal reaction(grade 1-2,17.3%;grade 3,2.2%),thrombocytopenia(grade 1-2,21.7%;grade 3,2.2%),and radiothermitis(grade 1-2,39.2%).The incidence of grade 3-4 adverse effects was 17.4%.No grade 5 toxicities were observed.Clinical complete response,partial response,stable disease,and progressive disease were observed in 1(2.2%),31(67.4%),12(26.1%),and 2(4.3%)patients,respectively.The median overall survival(OS)and progression-free survival(PFS)were 17 and 10 months,respectively.The 2-,3-,and 5-year OS and PFS rates were 30.4%,21.7%,19.6%,and 26.1%,19.6%,19.6%,respectively.Conclusions:Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates.Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

Comparison of involved-field intensity-modulated radiotherapy combined with S-1 vs radiotherapy alone for elderly patients with esophageal cancer

BACKGROUND It is estimated that about 30%of esophageal cancer(EC)patients are over 70 years old.Therefore,there is less evidence on the diagnosis and management of elderly EC patients.It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens,including the target area of radiotherapy(RT),radiation dose and fraction,and choice of chemotherapy drugs.AIM To compare the efficacy of involved-field intensity-modulated RT(IF-IMRT)combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety,short-term response,and survival.METHODS Thirty-four EC patients aged>70 years were prospectively enrolled between December 2017 and December 2019.Based on the random number table,they were divided into an IF-IMRT+S-1 group and an IF-IMRT alone group,with 17 patients in each group.All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions(1.8-2 Gy/fraction,5 fractions/wk).Oral S-1 was administered concomitantly in the IF-IMRT+S-1 group for 14 consecutive days,and a second cycle was started 7 d after drug withdrawal.After RT,4 cycles of S-1 treatment were offered as the consolidation chemotherapy.The safety,short-term response,and survival were observed after the treatment.RESULTS As of April 2022,these 34 patients had been followed up for 15.2-32.5 mo,with a median follow-up period of 24.5 mo.Complete efficacy indicators were obtained from all the patients.The objective response rate was 88.2%vs 76.5%,respectively,in the IF-IMRT+S-1 group and the RT alone group,where as the disease control rate was 100%vs 82.4%,respectively.The incidence of adverse events including grade 1-2 fatigue,granulocytopenia,thrombocytopenia,anemia,radiation esophagitis,radiation-induced skin injury,and radiation-induced lung injury was not significantly different between these two groups,so was the incidence of the grade 3 radiation esophagitis(0%vs 5.7%).The rate of progressive disease(PD)was 52.9%(n=9)in the IF-IMRT+S-1 group and 64.7%(n=11)in the RT alone group.The median progression-free survival(PFS)was 23.4 mo vs 16.3 mo,and the 2-year PFS rate was 42%vs 41.2%.The median overall survival(OS)was 27.0 mo vs 23.0 mo,and the 2-year OS rate was 58.8%vs 47.1%.Multivariate analysis showed that age was a significant prognostic factor(P=0.0019);patients aged<75 years had a significant survival advantage over patients aged≥75 years.The locations of EC also affected the prognosis.In the IFIMRT+S-1 group,the number of chemotherapy cycles was a significant prognostic factor(P=0.0125),and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.CONCLUSION Compared with IF-IMRT alone,IF-IMRT+S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions.Therefore,this concurrent radiochemotherapy deserves clinical application.

The peri-operative changes of T-lymphocyte subsets in the elder esophageal carcinoma patients

Objective:The aim of the study was to observe and compare the trend of T-lymphocyte subsets in the elder and adult esophageal carcinoma patients postoperatively. Methods: Forty-four esophageal carcinoma patients, classified as ASA physical status I-II, were divided into two groups. Twenty-two patients aged than 65 years were grouped as elder patient group, and the rest twenty-two patients, served as adult patient group, were younger than 60 years old. The jugular venous blood samples were collected before induction of anesthesia (T1) as baseline, after completion of surgery (T2), on the first, second and fifth postoperative days (T3, T4 and T5), respectively. The blood counts of CD3+, CD4+ and CD8+T-lymphocyte were measured by flow cytometer. Results: Compared with the baseline level, the blood CD3+, CD4+ and CD4/CD8 levels were significantly decreased immediately after surgery, on the first and second postoperative days in the two groups (P<0.01), which returned to baseline values on the fifth postoperative day (P>0.05). On the fifth postoperative day, CD3+, CD4+ and CD4/CD8 levels in adult group were significantly higher than those in elder group (P<0.05). Conclusion: The postoperative immune function in elder patients recovered more slowly than that in adult.

The influence of neoadjuvant chemotherapy on immunity function in elderly patients with the stages of Ⅱ and Ⅲ esophageal cancer

Objective: We aimed to study the influence of neoadjuvant chemotherapy on immunity function in elderly patients with the stages of II and III esophageal cancer. Methods: Thirty-seven elderly patients (age ranged from 60 to 75 years) with the stages of II and III esophageal cancer underwent 2 cycles chemotherapy preoperatively with single-drug regimen (docetaxel, 35 mg/m2 once a week, on days 1, 8 and 15, at interval of 2 weeks for one cycle). Surgery were performed three weeks later. Blood samples were drawn separately on the day of admission, 1 day before operation, 7 day and 1 month after operation, and we conducted the Flow Cytometry to detect the levels of CD3+, CD4+, CD8+,CD4+/CD8+ and NK cells. Results: There were no significant differences in the levels of CD3+, CD4+, CD8+, CD4+/CD8+ and NK cells between before and after chemotherapy (P > 0.05). On day 7 after operation, the levels of CD3+, CD4+, CD4+/CD8+ and NK cells were degraded and CD8+ increased significantly (P < 0.05). One month after operation, the levels of CD3, CD4+, CD4+/CD8 and NK cells were higher than normal, and CD8 was depressed significantly (P < 0.05). Conclusion: Neoadjuvant chemotherapy has no significant impact on cellular immune function in elderly patients with the stages of II and III esophageal cancer, it is an effective and safe treatment.

Effect of kanglaite injection and docetaxel in treating advanced stage esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients

Objective:To investigate the effect of Kanglaite injection combined with docetaxel in advanced esophageal cancer on tumor markers, angiogenesis and immune function in elderly patients.Method:A total of 130 patients with advanced esophageal cancer admitted in our hospital from October 2014 to July 2017were selected and divided into two groups according to the time of admission, 65 cases in each group, set as observation group and control group, all patients were treated with conventional radiotherapy (cisplatin combined with 5-fluorouracil), the observation group was given Kanglaite injection combined with docetaxel on the basis of this, while the control group only was given docetaxel treatment, the treatment period was 6 weeks, tumor markers, VEGF and immune function of both group after treatment were compared.Result: After treatment, the levels of carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9) and carcino-embryonic antigen (CEA) in the observation group were lower than those in the control group, the difference was statistically significant;VEGF level in the observation group after treatment was lower than the control group, the difference was statistically significant;After treatment, the levels of CD3+, CD4+ and CD4+/CD8+ in the observation group were higher than those in the control group, while the levels of CD8+ in the observation group was lower than those in the control group, the difference was statistically significant.Conclusion: Kanglaite injection combined with docetaxel in the treatment of elderly patients with advanced esophageal cancer is better, effectively reducing the level of tumor markers and vascular endothelial growth factor, improve immune function, it isworthy of clinical application.

老年食管癌三维适形与调强放射治疗疗效比较

目的比较老年食管癌三维适形放射治疗(3D-CRT)或调强放疗(IMRT)的疗效及其预后相关因素。方法回顾性分析153例65岁以上老年食管癌患者的临床资料,105例行3D-CRT、48例行IM-RT,采用SPSS11.5统计软件比较分析生存率及预后影响因素。结果放疗后食管造影评价CR71例、PR78例、NR4例,总有效率(CR+PR)为97.4%;全组1、3年生存率和局部控制率分别为70.6%、34.2%和76.2%、51.1%。3D-CRT与IMRT组资料相比,IMRT组胸中下段及淋巴结转移者较多、CT食管肿瘤最大径较大、放疗剂量更高、联合化疗者更多(P<0.05);而性别、年龄、T分期、放疗前进食情况及食管造影长度两组间比较差异无统计学意义(P>0.05)。3D-CRT与IMRT组1、3年生存率和局部控制率比较,差异无统计学意义(P>0.05),分层分析中两组生存率比较,差异无统计学意义(P>0.05)。全组单因素分析显示,治疗前进食情况、病变部位、T分期、淋巴结转移与否、食管造影显示病变长度、CT肿瘤最大直径、化疗和近期疗效与预后生存有关(P<0.05);Cox多因素分析仅化疗和CT肿瘤最大直径为独立预后因素(P<0.05)。结论老年食管癌IMRT与3D-CRT比较无明显生存优势,联合化疗及肿瘤最大直径小者放疗疗效较好,但需进一步前瞻性研究。

高龄食管癌的围手术期处理

目的:探讨70岁以上高龄食管癌的围手术期处理经验。方法:回顾分析155例70岁以上食管癌患者的围手术期治疗情况,其中行经左胸切除肿瘤、胃-食管弓下吻合95例;经左胸切除肿瘤、胃-食管弓上吻合27例;经左胸切除肿瘤、胃-食管颈部吻合12例;经右胸、颈、腹部三切口切除肿瘤、胃-食管颈部吻合12例,探查手术9例。结果:全组手术后共发生并发症11例,并发症发生率为7.10%,早期死亡2例,死亡率1.29%。1年生存率为40.5%,3年生存率为25.5%。结论:在合理掌握适应证的前提下,高龄食管癌的近、远期效果与普通食管癌手术相似。

65例高龄食管癌术后肺部并发症危险因素的多因素分析

[目的]探讨高龄食管癌术后肺部并发症的危险因素及其防治。[方法]采用病例对照研究方法,对2002年1月～2005年6月期间的高龄食管癌手术患者进行调查,并对术后肺部并发症可能的危险因素进行Logistic回归分析。[结果]多因素非条件Logistic逐步回归分析显示:FEV1/FVC<70%、贫血、吸烟史、术前放疗、手术时间超过4h、吻合口平面在主动脉弓上是食管癌术后肺部并发症的主要危险因素;术后镇痛是保护因素。[结论]对于高龄食管癌患者应做好充分的术前准备,选择合适的术式,术后常规镇痛。

美托洛尔对老年食管癌患者围术期心脏功能的保护作用

背景与目的:老年食管癌手术患者逐渐增多,围术期如何保护心脏功能,减少老年患者围术期心脏并发症的发生率及其死亡率成为目前亟待解决的问题之一。β受体阻滞剂在围术期的预防性应用被逐渐受到重视。本研究拟探讨美托洛尔对老年食管癌患者围术期心脏功能的保护作用。方法:将择期开胸手术的老年食管癌患者随机分为美托洛尔组(患者从麻醉诱导前至术后72h应用美托洛尔调节心率)和对照组(不给予美托洛尔),每组患者30例。分别记录两组术前、给药后、麻醉诱导后2min、插管、插管后4min、切皮、进胸、手术开始后1h、手术结束前10min、手术结束、拔管及拔管后15min的血流动力学指标和肌钙蛋白水平;并统计围术期发生心脏并发症的患者例数及术后窦性心动过速例数。结果:对照组患者气管插管时收缩压升高,与术前比较差异有显著性(P<0.05);气管插管及气管拔管时心率增快,与术前比较差异有显著性(P<0.05)。而美托洛尔组患者在上述各时间点收缩压、心率与术前相比差异无显著性(P>0.05)。对照组患者围术期有3例肌钙蛋白阳性,美托洛尔组无阳性病例,两组比较无显著性差异(P=0.237)。对照组有6例患者发生心脏并发症,美托洛尔组患者未发生心脏并发症,两组比较差异有显著性(P=0.024)。对照组中2例患者发生急性心肌缺血,4例患者发生房颤,两组患者围术期均未发生心肌梗塞及死亡。对照组患者术后发生窦性心动过速有15例,美托洛尔组有6例,两组比较差异有显著性(P<0.05)。结论:美托洛尔能降低老年食管癌患者围术期心脏并发症及术后窦性心动过速的发生率,有效抑制气管插管和气管拔管导致的心率增快或血压升高。

替吉奥同步化疗联合放疗治疗老年食管癌的临床疗效分析

目的:观察替吉奥同步化疗联合放疗治疗老年食管癌的临床疗效及不良反应。方法:回顾性分析老年食管癌病人70例临床资料,其中接受单纯放疗和同步化疗病人各35例。2组均全程采用三维适形调强放疗,同步化疗组同时采用替吉奥胶囊单药化疗。按照实体瘤评价标准(完全缓解、部分缓解、疾病稳定和疾病进展)评价近期疗效,并采用NCI-CTC对不良反应进行评定。随访2年,比较2组的中位生存时间和总生存率。结果:同步化疗组治疗总有效率为85.71%(30/35),高于单纯放疗组的60.0%(21/35)(χ^2=5.85,P<0.05)。2组均未出现因不良反应致死或终止治疗的病人,病人均能较好耐受,2组Ⅲ~Ⅳ级骨髓抑制及放射性食管炎发生率差异均无统计学意义(P>0.05)。随访2年,同步化疗组和单纯放疗组分别有1例和3例病人失访,同步化疗组中位生存时间和2年生存率分别为24.0个月和73.53%(25/34),均高于单纯放疗组的18.0个月和46.88%(15/32)(P<0.05)。结论:替吉奥同步化疗联合放疗治疗老年食管癌近期疗效较好,不良反应较小,可提高老年病人生存率。

老年食管癌病人术后经三腔胃肠营养管早期肠内营养的临床研究

目的:探讨三腔胃肠管在老年食管癌病人手术后早期肠内营养(EEN)的应用价值。方法:选取42例老年食管癌病人,每组21例,随机分为单腔普通营养管(胃肠减压管+鼻肠管)组和经鼻置三腔胃肠管组,术后24 h开始给予EN,同时对比置管成功率、病人出现呕吐、腹泻等不耐受情况的比例、达到预期营养目标的比例、感染发生率等,并在第8天复查肝、肾功能,评价三腔胃肠管在老年食管癌病人术后的应用价值。结果:三腔胃肠管在胃肠减压的同时,还可进行EN,降低了并发症的发生率。进行EEN未发现严重不良反应。结论:老年食管癌病人术后采用三腔胃肠管进行EEN安全可行。

管状胃在高龄食管癌和贲门癌根治术中的应用

目的总结70岁以上高龄食管癌、贲门癌根治手术中应用管状胃代食管的手术操作方法,分析术后肺部并发症的发生及术后生存的情况。方法回顾分析30例70岁以上高龄食管癌和贲门癌患者临床资料,术中应用管状胃代替食管,统计分析术后发生的肺部并发症和随访资料。结果术中保留胃右动脉及分支的管状胃制作成功,23例术后无明显肺部并发症发生,4例出现明显肺部感染,积极治疗后康复出院;2例术后气管切开,呼吸机辅助呼吸,1周后顺利脱离呼吸机;1例较长时间呼吸机辅助呼吸,出现吻合口瘘,最终死亡。术后随访21例,无明显反流性食管炎发生,术后1月后生活基本自理。1、3年生存率分别为42.8%(9/21)和19.0%(4/21)。结论应用管状胃代食管,对高龄食管癌和贲门癌患者,可以有效预防吻合口瘘,减少胸腔胃对心肺功能的影响,减少反流性食管炎的发生,提高患者术后生存质量。

70岁以上老年食管癌患者手术治疗的预后因素分析

目的:探讨70岁以上老年食管癌患者术后生存情况及其影响因素。方法:回顾性分析2000年1月至2009年12月广东省梅州市人民医院手术治疗的70岁以上食管癌患者62例的临床资料,采用单因素和多因素方法分析影响预后的各种因素。结果:全组总的5年生存率为26.2%。年龄、手术性质、浸润深度、淋巴结转移和TNM分期是影响患者预后的主要因素,其中手术性质、淋巴结转移、病理分期为独立预后因素结论:老年食管癌患者术前应全面检查,尽量避免单纯探查手术和姑息手术。手术应强调规范化与个体化兼顾的原则,加强围术期呼吸道管理,积极防治呼吸系统并发症。

42例老年性食管癌手术治疗分析

本文报告４２例老年食管癌病人的外科治疗结果，男性３５例，女性７例，年龄６０～８０岁，平均６５．７岁。术前２３例病人有心电图异常，９例有慢性肺疾患，１２例有其它的伴存疾病。本文对老年食管癌的特点、术前准备，围手术期的监护和处理进行了讨论。

胸外科老年患者术后谵妄的临床分析

目的:分析胸外科老年患者术后谵妄(POD)的发生率及相关危险因素。方法:对388例老年非心脏择期手术患者应用ICU谵妄诊断的意识状态评估法(CAM-ICU)进行POD评定,对肺部疾病组、食管疾病组及纵隔疾病组的POD发生率进行比较,并对食管疾病组中各危险因素进行分析。结果:食管疾病组POD的发生率为26.4%,明显高于肺部疾病组的7.0%和纵隔疾病组的2.3%。术前合并糖尿病、既往脑血管病史、手术时间长、术后中心静脉置管、术后鼻胃管留置时间长、术后鼻十二指肠管留置时间长以及术后SICU住院时间长是食管疾病患者POD的独立危险因素。结论:在胸外科老年病人的非心脏择期手术中,食管疾病患者POD的发生率显著高于其他疾病患者。术前合并糖尿病、既往脑血管病史的食管疾病患者是术后谵妄的易感人群,缩短手术时间、减少术后体内各管道的留置时间及SICU的住院时间可能会降低术后谵妄的发生率。

老年食管癌加速超分割放射治疗的临床探讨

目的:探讨老年食管癌加速超分割放射治疗的疗效、毒副作用和并发症。方法:将96例患者随机分为常规治疗组(CF)和加速超分割治疗组(CAF)。CF组:每次1.8～2.0Gy,总剂量60～70Gy/30～35fx。CAF组:每天照射2次,每次1.5Gy,总剂量54Gy/3.5w,两组患者均用60Co-γ射线外照射。结果:两组患者均顺利完成了疗程,其1、3、5年生存率CF组分别为45.8%(22/48)、18.8%(9/48)、12.5%(6/48);CAF组分别为70.8%(34/48)、39.6%(19/48)和29.2%(14/48),CAF组疗效明显优于CF组(P<0.05)。毒副作用主要表现为放射性食管炎和放射性气管炎,但均无统计学差异。并发症中,早期以食管穿孔、食管出血为主要表现,晚期主要表现为食管缩窄、咯血及持续性咳嗽,两组相比无统计学意义。结论:CAF组患者能耐受根治性放疗;CAF组患者放疗的毒副作用及并发症较CF组明显,但两组发生率无统计学意义。

食管贲门双源癌癌组织中人乳头瘤状病毒和P16^INK4A、P21^WAF1蛋白检测

目的:探讨食管贲门双源癌癌组织中人乳头瘤状病毒(HPV)感染、P16INK4A、P21WAF1蛋白表达与食管贲门癌变的关系。方法:采用PCR检测17例双源癌食管鳞癌(SCC)和贲门腺癌(GCA)组织HPV16型DNA(HPV16-DNA),采用免疫组织化学方法检测P16INK4A、P21WAF1蛋白的表达。结果:17例SCC组织中HPV16-DNA检出率为8/17,GCA组织为5/17,且有2例患者SCC和GCA组织中同时检测到HPV16-DNA。2种组织中P16INK4A和P21WAF1蛋白均有不同程度表达,且表达的一致性较高(P均>0.05)。SCC、GCA组织中P16INK4A、P21WAF1蛋白表达与HPV16感染无关(P>0.05)。结论:HPV可能是SCC和GCA共同相关致病危险因素。

不同镇痛方式对食管癌手术后护理的影响

目的:比较硬膜外自控镇痛(PCEA)和静脉自控镇痛(PCIA)对缓解胸部手术患者术后疼痛的影响。方法:将86例食管癌手术患者随机分为E组(n=43)和I组(n=43),分别使用PCEA和PCIA镇痛,观察2组镇痛效果。结果:术后5 d内视觉模拟评分、使用辅助药物治疗镇痛的用量、术后拔管时间、ICU住院时间、术后开始走路时间和住院时间,2组差异均有统计学意义(P<0.01)。E组发生肺部并发症3例,I组14例;E组发生吻合口漏2例,I组6例;E组术后发生谵妄2例,I组6例,差异均无统计学意义(P>0.05)。结论:食管癌患者开胸手术术后PCEA优于PCIA,对改善食管癌手术后护理、减少住院时间和促进患者康复有着积极的意义。