Fox Chase Researchers Examine Treatment Toxicities in Older Esophageal Cancer Patients

PHILADELPHIA (July 27, 2020)—Researchers at Fox Chase Cancer Center found in a recent study that older patients who underwent chemoradiation therapy followed by removal of their esophagus due to cancer had toxicities and outcomes similar to younger patients.

An esophagectomy is a surgery to remove part or all of the esophagus, which is then reconstructed using part of another organ, usually the stomach. Chemoradiation followed by an esophagectomy is considered the standard of care for locally advanced esophageal cancer.

“Clinical trials tend to enroll younger patients. Therefore, it’s hard to extrapolate and treat older patients based on the results of trials in younger patients,” said Rishi Jain, MD, MS, DABOM, lead author on the study and assistant professor in the Department of Hematology/Oncology at Fox Chase, and a member of the Cancer Prevention and Control Program.

“We wanted to take a closer look at how older patients did with esophageal cancer, specifically in terms of side effects or toxicities and survivals. These results are important to know, because unfortunately sometimes people use age to decide how to treat patients and maybe older patients aren’t offered aggressive treatments,” said Jain.

Jain worked on the study with Joshua E. Meyer, MD, an associate professor in the Department of Radiation Oncology, Efrat Dotan, MD, an associate professor in the Department of Hematology/Oncology, and other researchers at Fox Chase.

The study examined 125 patients with early stage esophageal cancer who were treated at Fox Chase. Patients were split into age groups of individuals over 65 and individuals under 65. Of those 125 patients, Jain said 58 were over the age of 65 and 25 percent of the trial population were over 70.

Researchers compared side effects of the age groups, which were broken down into categories of hospitalizations related to the treatment, hematologic toxicities—or blood count issues—as well as others.

Similar toxicities and outcomes between younger and older patients in the study suggest that preliminary chemoradiation before esophagectomy is safe in select older adults with esophageal cancer, Jain said.

Additionally, the researchers found that older patients did have a higher rate of blood count issues, specifically lower platelets. Jain said, however, that this can be expected because older individuals have lower reserves of bone marrow with which to rebound after a blood count issue. Researchers said platelet-to-lymphocyte ratios and neutrophil-to-lymphocyte ratios may be able to serve as prognostic markers of aging, toxicity, and outcomes.

Jain said the study highlights the fact that by using practices like comprehensive geriatric assessments, physicians can effectively assess what problems an older patient may have and make sure they are addressed while treatment for cancer is being pursued.

“It’s helpful to know that if you carefully select older patients, you can safely get them through the treatment without putting them at much higher risk for complications in comparison to younger patients who are almost always treated aggressively,” said Jain.

The study, “Treatment-Related Toxicity and Outcomes in Older Versus Younger Patients With Esophageal Cancer Treated With Neoadjuvant Chemoradiation,” was published in the Journal of Geriatric Oncology.

Fox Chase Cancer Center (Fox Chase), which includes the Institute for Cancer Research and the American Oncologic Hospital and is a part of Temple Health, is one of the leading comprehensive cancer centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase is also one of just 10 members of the Alliance of Dedicated Cancer Centers. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence six consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. It is the policy of Fox Chase Cancer Center that there shall be no exclusion from, or participation in, and no one denied the benefits of, the delivery of quality medical care on the basis of race, ethnicity, religion, sexual orientation, gender, gender identity/expression, disability, age, ancestry, color, national origin, physical ability, level of education, or source of payment.

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