title: Impact of age on the feasibility and efficacy of neoadjuvant chemotherapy in patients with locally advanced oesophagogastric cancer.
abstract: BACKGROUND
  Neoadjuvant chemotherapy (neoCTx) improves the prognosis of patients with localised oesophagogastric adenocarcinoma (EGC), but its value is unknown in elderly patients.
  
  
  METHODS
  Patients who received neoCTx followed by surgery for EGC between 2000 and 2012 were analysed. The aim of this study was to compare the feasibility and outcome between patients aged ⩾70 (cohort I) and their younger counterparts (cohort II).
  
  
  RESULTS
  Data were available for 460 patients among which 174 (38%) were ⩾70 years. Older age was associated with an increased rate of comorbidities (66% versus 42%, p<0,001). As compared to the younger, elderly patients were more likely to receive doublet instead of triplet neoCTx (65% versus 37%, p<0.001) and oxaliplatin-instead of cisplatin-based regimens (60% versus 32%, p<0.001). No significant difference was observed in the rate of ⩾grade 3 toxicities for cohort I and II (48% versus 41%) and postoperative morbidity was also not different (24% versus 28%). 90 day mortality for cohort I and II was 6.5% and 3.9%. After a median follow-up of 38 months, median disease-free survival (DFS) was 29.4 months in cohort I and 33.8 months in cohort II, with a 5-years DFS of 37% and 40%, respectively. Median overall survival (OS) was not reached in cohort I and was 58.4 months in cohort II, with a 5-year OS of 51% and 50% for cohort I and II, respectively.
  
  
  CONCLUSIONS
  Despite slightly more adverse events and dose reductions, neoCTx is feasible in elderly patients with EGC. Elderly patients achieve comparable survival outcomes compared with their younger counterparts.
authors.affiliation: 3rd Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany. Electronic address: sylvielorenzen@gmx.de.
authors.forename: Lorenzen
authors.initials: L
authors.lastname: Sylvie
authors.affiliation: 3rd Department of Internal Medicine (Hematology/Medical Oncology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Spoerl
authors.initials: S
authors.lastname: Silvia
authors.affiliation: Krankenhaus Nordwest, UCT University Cancer Center, Frankfurt am Main, Germany.
authors.forename: Al-Batran
authors.initials: AB
authors.lastname: Salah-Eddin
authors.affiliation: Department of Surgery, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen, Germany.
authors.forename: Feith
authors.initials: F
authors.lastname: Markus
authors.affiliation: University Cancer Center Leipzig (UCCL), University Medicine Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Lordick
authors.initials: L
authors.lastname: Florian
authors.affiliation: Department of Haematology, Oncology and Tumorimmunology, Campus Virchow-Klinikum, Charite-University Medicine Berlin, Berlin, Germany.
authors.forename: Thuss-Patience
authors.initials: TP
authors.lastname: Peter
authors.affiliation: Institute for Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany.
authors.forename: Haller
authors.initials: H
authors.lastname: Bernhard
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Hospital of the University of München, Munich, Germany.
authors.forename: Angele
authors.initials: A
authors.lastname: Martin
authors.affiliation: Department of Surgery, Klinikum rechts der Isar der Technischen Universitaet Muenchen, Muenchen, Germany.
authors.forename: Novotny
authors.initials: N
authors.lastname: Alexander
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D015897:Comorbidity; D018450:Disease Progression; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Elderly patients; Neoadjuvant chemotherapy; Oesophagogastric adenocarcinoma; Toxicity