KEY POINTS
- This single-center retrospective study included 88 patients aged ≥65 years with nonmetastatic esophageal squamous cell carcinoma treated with definitive chemoradiotherapy during 2023–2024. Median age was 76 years; 83% had T3–4 disease, 78% node-positive disease, and 64% stage III disease.
- IMRT delivered 50–60 Gy in 1.8–2.0-Gy fractions with concurrent single-agent chemotherapy. Treatment was strongly skewed toward oral fluoropyrimidines: 83/88 patients (94.3%) received S-1 or capecitabine and only five received cisplatin, limiting conclusions about other chemoradiotherapy regimens.
- Median follow-up was 24 months. Median progression-free survival was 16 months and median overall survival 25 months; among 74 patients with assessable post-treatment imaging, 53 (71.6%) achieved complete or partial response.
- Increasing age independently predicted worse overall survival, with a 4.7% increase in mortality hazard per additional year (HR 1.047, 95% CI 1.000–1.095; p=0.048). Increasing CIRS-G comorbidity score was also independently adverse (HR 1.179 per point, 95% CI 1.014–1.376; p=0.032).
- Nutritional status predicted disease control rather than overall survival. Each one-point increase in GNRI was associated with a 3.6% lower risk of progression or death (HR 0.964, 95% CI 0.932–0.995; p=0.019), while baseline systemic immune-inflammation index was not significantly associated with either endpoint.
- The authors constructed a simple score assigning one point each for age ≥75 years and CIRS-G ≥7. Patients with both factors had median overall survival of 16 months, versus median not reached for patients with zero or one factor (log-rank p=0.00093). GNRI ≥98 similarly identified patients with longer progression-free survival (p=0.046).
- No treatment-related deaths occurred. Grade ≥3 neutropenia/leukopenia and esophagitis each occurred in 10.2%, pneumonitis in 3.4%, and nausea/vomiting in 2.3%. High-risk patients had more neutropenia/leukopenia (15.0% vs 6.3%) and pneumonitis (5.0% vs 2.1%), but event numbers were too small for formal comparative inference.
CLINICAL TAKEAWAY
Chronologic age alone is a crude measure of treatment fitness; combining it with a structured comorbidity assessment may better identify elderly patients with particularly poor prognosis during definitive chemoradiotherapy. This two-item score is attractive for its simplicity, but it is not yet a validated treatment-selection tool and does not establish that chemotherapy should be de-intensified in high-risk patients.