Introduction

Since the early 2010s, neoadjuvant chemoradiation followed by esophagectomy (trimodal therapy) has been a recommended treatment for patients diagnosed with locally advanced esophageal cancer. However, it may also add treatment-related toxicity, particularly for older adults with significant comorbidity and frailty burdens. We examined contemporary patterns of care in older adults, which have not been well characterized.

Materials and Methods

We used the Surveillance Epidemiology and End Results-Medicare database to identify a cohort of US adults aged 66 years and older diagnosed with incident locally advanced esophageal cancer between 2004 and 2017. Calendar year age-standardized percentages of treatment receipt were calculated. Joinpoint regression was used to detect temporal trends in treatment receipt. Descriptive associations between patient factors and treatment were assessed. Trend analyses quantified how the percentage of trimodal and definitive chemoradiation (no surgery) patients receiving cisplatin-based, carboplatin-based, and other chemotherapy regimens evolved over time.

Results

In total, 4332 adults aged ≥66 years with locally advanced esophageal cancer were included. The age-standardized percentage of patients receiving trimodal therapy increased from 16.7% in 2004 to 26.1% in 2017 (annual percent change = 3.5%; 95% confidence interval [CI], 0.7%–6.4%) in adenocarcinomas and from 7.3% in 2004 to 9.1% in 2017 (annual percent change = 0.4%; 95% CI, −4.1%–5.1%) in squamous cell carcinomas. By 2017, definitive chemoradiation became the most frequently used treatment modality for adenocarcinomas (49.8%; 95% CI, 43.5–56.0) and squamous cell carcinomas (59.5%; 95% CI, 50.8–68.2). Patients with higher comorbidity and frailty burdens were less likely to be treated with trimodal therapy. Amongst patients receiving chemoradiation as part of their treatment, a large and swift channeling away from cisplatin and towards carboplatin-based regimens was observed.

Discussion

In practice, definitive chemoradiation is the most commonly received treatment by older adults with locally advanced esophageal cancer. Four out of five older adults do not receive trimodal therapy, some of whom are potentially undertreated.

中文翻译：

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诊断为局部晚期食管癌的老年人的护理模式：一项队列研究

介绍

自 2010 年代初以来，新辅助放化疗后食管切除术（三联疗法）一直是诊断为局部晚期食管癌患者的推荐治疗方法。然而，它也可能增加治疗相关的毒性，特别是对于有严重合并症和虚弱负担的老年人。我们研究了老年人的当代护理模式，这些模式尚未得到很好的表征。

材料和方法

我们使用 Surveillance Epidemiology and End Results-Medicare 数据库确定了 2004 年至 2017 年间诊断为局部晚期食管癌的 66 岁及以上美国成年人队列。计算了日历年年龄标准化的治疗接受百分比。连接点回归用于检测治疗接受的时间趋势。评估了患者因素和治疗之间的描述性关联。趋势分析量化了接受基于顺铂、基于卡铂和其他化疗方案的三峰和根治性化放疗（非手术）患者的百分比如何随时间演变。

结果

总共纳入了 4332 名年龄≥66 岁的局部晚期食管癌成人。接受三联疗法的年龄标准化患者百分比在腺癌中从 2004 年的 16.7% 增加到 2017 年的 26.1%（年百分比变化 = 3.5%；95% 置信区间 [CI]，0.7%–6.4%），在腺癌中从 7.3% 增加2004 年至 2017 年的 9.1%（年度百分比变化 = 0.4%；95% CI，-4.1%–5.1%）在鳞状细胞癌中。到 2017 年，根治性放化疗成为腺癌（49.8%；95% CI，43.5-56.0）和鳞状细胞癌（59.5%；95% CI，50.8-68.2）最常用的治疗方式。合并症和虚弱负担较高的患者不太可能接受三联疗法。在接受放化疗作为治疗一部分的患者中，

讨论

在实践中，根治性放化疗是患有局部晚期食管癌的老年人最常接受的治疗。五分之四的老年人没有接受三联疗法，其中一些人可能治疗不足。