Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death related to cancer. In the United States, there are over 16,000 people diagnosed with the disease annually with an even higher prevalence in other parts of the world. The National Comprehensive Cancer Network (NCCN) guidelines suggest surgery as the standard treatment for stage I esophageal cancer. Despite these guidelines, various factors prevent a patient from being managed surgically such as age of the patient, multiple comorbidities and differences in sociodemographic and socioeconomic status. The median age of patients diagnosed with esophageal cancer is around 67 years with a 5-year overall survival (OS) rate of 18.8%. Age often drives treatment decisions of elderly patients (? 80 years of age) representing a unique and challenging subpopulation to health care providers. Randomized clinical trials have shown that survival of patients with esophageal cancer correlates with the degree of treatment intensity they receive. However less aggressive, nonsurgical therapy such as chemoradiation is commonly provided to elderly patients even with early-stage disease.
A group of researchers in the United States conducted a retrospective study to evaluate the practice patterns and outcomes of elderly patients (? 80 years of age) with stage I esophageal cancer who received four different types of treatment: esophagectomy (Eso), local excision (LE), chemoradiotherapy (CRT) and observation (Obs). The National Cancer Data Base (NCDB) was queried for patients ? 80 years of age diagnosed with cT1-T2 N0 esophageal cancer from 2004 to 2012. Patients meeting the criteria were divided into four groups: Eso, LE, CRT, and Obs. Patient, tumor, and treatment parameters were extracted and compared. Analyses were performed on OS and postoperative 30- and 90-day mortality.
Dr. Stegall’s Comments: With cancer, time is your biggest enemy. Tumor biology has taught us that cancer cells grow faster than normal cells, and are immortal unless we kill them. The longer we leave cancer untreated in the body, the faster it is likely to grow and spread. As a result, I am not surprised at the above study results.