Efficacy and Safety of Chemoradiotherapy with Carboplatin and Paclitaxel in Older Adults with Esophageal Cancer

Abstract Background: Concurrent chemoradiotherapy (CCRT) using the paclitaxel/carboplatin regimen, as established in the CROSS study, has become a standard neoadjuvant treatment prior to surgery for patients with locally advanced esophageal cancer. However, its impact on older patients requires further study to guide clinical decision making. Materials and Methods: This retrospective analysis included 87 patients with locally advanced esophageal cancer treated at three institutes in Taiwan between 2016 and 2017. All patients received CCRT comprising weekly carboplatin and paclitaxel combined with intensity-modulated or arc radiotherapy. Survival, treatment efficacy, adverse events, and complications were assessed and stratified by age groups (<65 vs. ≥65, <70 vs. ≥70, and <75 vs. ≥75 years). Results: The 1- and 2-year survival rates were 71.0% and 55.5%, respectively, for patients <65 years, and 72.2% and 61.0% for patients aged ≥65 years, with no significant differences across age groups. The objective response rate was 76%, consistent across all age subgroups. Surgical resection was performed in 49% of the patients, achieving a 77% complete (R0) resection rate across age groups. Toxicities were prevalent but not age-specific in most cases, with 75% of the patients experiencing adverse events. Hematological toxicities were common, with leukopenia (32%) and anemia (17%) being the most frequent. Nonhematological toxicities included mucositis (23%) and infection (17%). Older patients had a higher incidence of hypertension during treatment (≥70 years: 23% vs. 3%, P = 0.022). Emergency visits and hospitalizations occurred in 30% and 24% of the patients, respectively, during CCRT, without significant age differences. Conclusion: CCRT appears to be a feasible treatment option for selected patients with esophageal cancer, including older adults, with good performance status and preserved organ function.