Main Session
Sep 30
PQA 08 - Gastrointestinal Cancer, Nonmalignant Disease, Palliative Care

3486 - Optimization of Radiotherapy Modality in Elderly Esophageal Cancer Patients: A Decade-Long Retrospective Survival Analysis

02:30pm - 03:45pm PT
Hall F
Screen: 9
POSTER

Presenter(s)

Yan Luo, PhD - Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, Chongqing

Y. Luo1, Q. Zhou2, Q. Luo2, C. Fan3, Q. Guo2, Q. Lei4, C. Li Jr2, and S. Suting5; 1Radiation Oncology Center, Chongqing University Cancer Hospital,, Chongqing, Chongqing, China, 2Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, China, 3Oncology Radiotherapy Center of Chongqing University Cancer Hospital, Chongqing, China, 4Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, chongqing, China, 5Chongqing University Cancer Hospital, Chongqing, Chongqing, China

Purpose/Objective(s): To evaluate survival benefits of radiotherapy (RT) in elderly esophageal cancer patients and compare outcomes across multimodal RT approaches (CCRT(concurrent chemoradiotherapy), IC (Induction chemotherapy) + RT, IC + CCRT, RT alone), aiming to define the optimal therapeutic strategy for this vulnerable population.

Materials/Methods: This retrospective analysis included 3,279 esophageal cancer patients with 10-year follow-up (2013–2022). Cohorts were stratified by RT receipt (RT: 908 vs. non-RT: 2,371). Elderly patients (=65 years, n=415) and younger counterparts (<65 years, n=493) were compared within the RT cohort. Subgroup analyses focused on elderly patients receiving distinct RT modalities:

  • CCRT (n=132) vs. non-CCRT (n=283)

  • IC-based regimens (IC + RT/CCRT, n=81) vs. non-IC (n=177)

  • IC + RT (n=52) vs. RT alone (n=137)

  • IC + CCRT (n=29) vs. CCRT alone (n=40) Statistical methods included Kaplan-Meier survival estimates, Cox proportional hazards models, and log-rank tests (significance: P<0.05).

Results:

  1. Overall Survival Benefit of RT:

    • RT cohort demonstrated superior median OS (20.1 vs. 15.1 months, P<0.001; HR=0.81).

    • Elderly patients had worse survival than younger patients (median OS: 19.0 vs. 23.3 months, P=0.0203; HR=1.21).

  2. Elderly-Specific Modality Analysis:

    • CCRT significantly improved survival vs. non-CCRT (26.2 vs. 19.6 months, P=0.0213; HR=0.72).

    • IC failed to enhance outcomes in all scenarios:

      • IC + RT vs. RT alone: 19.6 vs. 18.6 months, P=0.9611; HR=1.02

      • IC + CCRT vs. CCRT alone: 15.2 vs. 32.7 months, P=0.4022; HR=1.31

    • RT alone yielded the poorest prognosis (median OS: 16.4 months).

Conclusion: Radiotherapy confers a significant survival advantage in esophageal cancer, but elderly patients require tailored strategies. Concurrent chemoradiotherapy emerges as the optimal modality for elderly populations, achieving a 6.6-month OS gain over non-CCRT regimens. In contrast, induction chemotherapy adds no survival benefit—even when combined with CCRT—and may paradoxically attenuate survival (15.2 vs. 32.7 months in IC + CCRT vs. CCRT alone, P=0.4022), suggesting potential treatment-related toxicity or selection bias. These findings advocate for omitting IC and prioritizing CCRT in elderly treatment paradigms.