title: Do elderly patients experience increased perioperative or postoperative morbidity or mortality when given neoadjuvant chemoradiation before esophagectomy?
abstract: BACKGROUND
  The use of induction chemoradiotherapy followed by surgery has been widely used for the treatment of esophageal cancer. The presumed risk of increased postoperative morbidity and mortality with this regimen has led to reluctance to offer this therapy to elderly patients. We compared the perioperative morbidity and mortality of patients 70 years old and older with those of patients younger than 70 who received CRT followed by esophagectomy and sought to identify preoperative risk factors that may predict higher risk of postoperative death or complications.
  
  
  METHODS
  We identified 260 patients who underwent preoperative chemoradiotherapy followed by esophagectomy. The association of age with postoperative death and complications was evaluated. The Charlson index, prior cardiac history, and diabetes were identified as preoperative risk factors and were evaluated as potential confounders or effect modifiers.
  
  
  RESULTS
  Cardiac disease and the Charlson index were potential modifiers of the effect of age on length of hospital stay (p = 0.08 and p = 0.07, respectively) and postoperative complications (p = 0.1 and p = 0.2) but were not statistically significant. There was a slight nonsignificant decrease in the risk of death in elderly patients after adjustment for the Charlson index (p = 0.2).
  
  
  CONCLUSIONS
  No significant differences were detected with respect to morbidity and mortality in elderly patients. The presence of cardiac disease, higher scores on the Charlson index, or diabetes did not significantly influence length of stay, postoperative complications, or postoperative death. Given the potential to improve outcomes, this regimen should not be discounted in elderly patients.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco, CA 94143, USA. foghse@radonc.ucsf.edu
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Fogh
authors.forename: Anthony
authors.initials: A
authors.lastname: Yu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Kubicek
authors.forename: Walter
authors.initials: W
authors.lastname: Scott
authors.forename: Edith
authors.initials: E
authors.lastname: Mitchell
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Rosato
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020360:Neoadjuvant Therapy / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality*; D016016:Proportional Hazards Models; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult