P-0055 - Perioperative chemotherapy of resectable gastroesophageal cancer in elderly patients: a retrospective analysis

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Oesophageal Cancer
Geriatric Oncology
Presenter Catarina Cardoso
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors C. Cardoso1, A. Moreira2, S. Mao Ferro1, M. Serrano1, S. Ferreira1, A. Dias Pereira1, R. Casaca3, A. Bettencourt1, J. Moleiro1, A. Pimenta1, C. Luís Ana2, J. Freire2
  • 1IPO Lisboa, Lisboa/PT
  • 2Portuguese Institute of Oncology in Lisbon, Lisbon/PT
  • 3IPO Lisboa, Lisbon/PT

Abstract

Introduction

Background: A perioperative regimen of ECF (epirubicin, cisplatin and infused fluorouracil) significantly improved progression-free and overall survival in resectable gastroesophageal cancer and a subgroup analyses confirmed this benefit for elderly patients (pts). Age ≥ 70 years is an independent prognostic factor for gastric cancer (GC) after gastrectomy and many elderly pts suffer from concomitant diseases that potentially compromise compliance to treatment plan.

Methods

Retrospective review of the clinical data from patients ≥70 years with gastric or gastroesophageal junction adenocarcinoma, diagnosed from February 2009 to June 2013 and proposed for perioperative chemotherapy. Our protocol excluded pts ≥ 80 years from chemotherapy. Comorbidities were evaluated by Charlson comorbidity index. Major toxicities during treatment were considered if they changed the treatment plan (dose reduction, treatment delay or suspension).

Results

149 pts were proposed to receive the perioperative regimen, 54 pts with ≥70 years, 34 male and 20 female, with median age of 74 years. The histological diagnosis was adenocarcinoma in 41 (75.9%) pts and poorly cohesive carcinoma in 13 pts (24.1%). 15 pts had gastroesophageal junction carcinoma. Stage was IIa in 15 pt, IIb in 22 pt, IIIA in 13 pt, IIIC in 4 pt (in 36 pts staging laparoscopy was done). The median Carlson comorbidity index was 7 (44 pts had more than 3 comorbidities). In 5 pts, cisplatin was replaced for oxaliplatin due to decreased renal function. 45 pts (83.3%) completed preoperative chemotherapy and underwent surgery (35 pts R0, 2 pts R1, 1 pt R2, 7 pts unresectable disease). Resection was curative in 35 of 54 pts (64.8%). Reasons that contraindicate surgery were disease progression in 4 pts, patient refusal in 2 pts, death related to chemotherapy toxicities in 2 pts (gastroenterological septic shock) and unknown cause in 1 pt. 25 pts started postoperative CT and 23 of 54 (42.6%) pts completed the protocol. Treatment suspension was required in 13 pts, chemotherapy dose reduction in 24 pts (main cause was gastroenterological toxicity) and chemotherapy delay in 12 pts (main cause was haematological toxicity). The Carlson comorbidity index was a predictive factor of toxicities and compliance with the treatment (2 dead pts from CT toxicities had an index of 8). With a medium follow up of 17.5 months, 17 pts died of progressive disease and 21 pts are alive in remission.

Conclusion

Age should not be considered a contraindication for perioperative chemotherapy in GC. Protocol compliance and resection curative rate were similar to the results of MAGIC trial, despite a higher median age in our group. There were important treatment side effects, including 2 deaths due to gastroenterological toxicities. Evaluating pt comorbidities and improving supportive care are important clues to increase compliance to treatment plan.

Objective

Reviewed the results of perioperative chemotherapy (CT) in elderly pts in our Institution, evaluating the compliance to treatment plan, the curative resection rate, treatment modifications due to toxicity and its relation to comorbidities.