Current and future treatment options for esophageal cancer in the elderly

ABSTRACT

Introduction: Esophageal cancer is the eighth most common cancer globally and has the sixth worst prognosis because of its aggressiveness and poor survival. Data regarding cancer treatment in older patients is limited because the elderly have been under-represented in clinical trials. Therefore, we reviewed the existing literature regarding treatment results for elderly patients (70+ years).

Areas covered: We used pubmed to analyze the actual literature according to elderly esophageal cancer patients with subheading of incidence, esophagectomy, chemoradiation or chemotherapy. The main points of interest were treatment options for patients with Barrett’s esophagus or early carcinoma, advanced tumor stages, and inoperable cancer.

Expert opinion: The incidence of esophageal cancer has been increasing over the past thirty years, with a rapid increase of esophageal adenocarcinoma in Western industrialized nations. Patients aged over 60 years have been particularly affected. In this review, we have shown that elderly patients with esophageal cancer have various alternatives for adequate treatment. Clinical evaluation of comorbidity is necessary to make treatment decisions. Therapeutic options for early carcinomas are endoscopic or surgical resection. For elderly patients with advanced carcinomas, preoperative chemoradiation or chemotherapy should be discussed.

KEYWORDS:

• Esophageal cancer
• elderly patients
• esophagectomy
• neoadjuvant therapy
• chemotherapy
• chemoradiation

Article highlights

• Esophageal cancer occurs mostly in patients older than 50 years with a median age of 68 years.

• Increasing incidence, especially of adenocarcinoma of the esophagus, and the climbing average life expectancy ensuring that more patients will present in their 70s, 80s, and 90s.

• There are hints that treatment of elderly esophageal cancer patients is fairly underutilized. It is necessary to offer adequate therapeutic options for those elderly patients. The decision should include life expectancy, comorbidity and quality of life.

• According to the physical status of the individual patient and the depth of tumor infiltration we offer a decision tree:

  • Barrett-esophagus: surveillance, endoscopic or surgical therapy

  • Early cancer: endoscopic or surgical therapy,

  • Advanced cancer: surgery with or without preoperative chemoradiation or chemotherapy or definitive chemoradiation.

• Clinical studies for elderly patients with esophageal cancer are necessary to optimize the therapeutic strategies.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded