title: Long-term results of definitive concurrent chemoradiotherapy using S-1 in the treatment of geriatric patients with esophageal cancer.
abstract: OBJECTIVE
  The aim of this study was to investigate the efficiency and safety of using S-1 as monotherapy and maintenance therapy combined with definitive concurrent radiotherapy for elderly patients with esophageal cancer.
  
  
  METHODS
  From January 2009 to December 2010, 68 elderly patients were included. Radiotherapy was delivered with a daily fraction of 1.8-2.0 Gy to a total radiation dose of 54.0-60.0 Gy. Preplanned concurrent S-1 (80 mg/m(2)/d) was given on days 1-14, every 3 weeks. After concurrent chemoradiotherapy, maintenance S-1 was repeated up to four cycles.
  
  
  RESULTS
  The median age of the enrolled patients was 76 years (range: 70-88 years), and the clinical stages were stage I (two patients), stage II (24 patients), stage III (28 patients), and stage IV (14 patients). A total of 51 (75.0%) patients finished treatment on schedule, with a median of five cycles of S-1, in which 35 (51.5%) patients achieved complete response. The median follow-up time was 42.7 months, and the median overall survival (OS) and progression-free survival (PFS) times were 25.7 months and 21.5 months, respectively. The 1-year, 3-year, and 5-year OS and PFS rates were 70.6%, 41.8%, and 25.9% and 68.1%, 32.9%, and 15.9%, respectively. Grade ≥3 neutropenia and leukopenia were found in 14 patients and 13 patients, respectively. The most common nonhematologic toxicity was esophagitis including six patients and one patient with grades 3 and 4, respectively. Multivariate analysis revealed that cycles of S-1 and complete response were strong factors for OS and PFS.
  
  
  CONCLUSIONS
  For geriatric patients with esophageal cancer, S-1 as monotherapy and maintenance chemotherapy in combination with definitive concurrent radiation therapy yielded satisfactory survival outcomes with tolerable toxicities. More studies are highly warranted to further clarify this issue.
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Shiliang
authors.initials: S
authors.lastname: Lv
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Fang
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Jia
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Wenming
authors.initials: W
authors.lastname: Zhan
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Yongshi
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Hong'en
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Radiotherapy, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Song
keywords: S-1; chemoradiotherapy; esophageal cancer; geriatric; survival