315 Tertiary Cancer Centre Experience of Delivering Pre-Operative Chemoradiotherapy for Oesophageal Cancer in Older Adults

Abstract Aim Neoadjuvant chemoradiotherapy (NACRT) prior to surgery is often used as part of a curative pathway for oesophageal cancer, especially for squamous cell carcinoma (SCC), following the CROSS trial. However, median age in CROSS was 60 years, whereas patients referred in practice are often older. This study evaluates tolerability and outcomes in patients ≥65. Method A retrospective review was conducted of patients aged ≥65 who received NACRT between January 2022 and October 2024 at Royal Surrey Cancer Centre. Results Eighteen patients met inclusion criteria. Median age= 72.5 years (range 65–76); 66.7%= male; 66.7% had SCC. 100% had performance status 0–1; 66.7% had ≥1 comorbidity. Staging was: T2–T3 in 94.4%, T4a in 5.6%; N0 in 33.3%, N1 in 50.0%, N2 in 16.7%. Median tumour length = 4 cm (range 3–11). 100% completed radiotherapy (41.4Gy in 23 fractions); 94.4% completed all chemotherapy cycles (weekly carboplatin AUC2, paclitaxel 50mg/m2). G1/2 toxicity was comparable to CROSS data: fatigue=72.2%, nausea/vomiting=61.1%, oesophagitis=61.1%, diarrhoea=27.8%. G3 toxicity=16.7% (fatigue n=1, oesophagitis n=2). 83.3% proceeded to surgery; pathological complete response = 33.3%. Reasons for not proceeding to surgery included patient choice and cardiovascular risk. 50% received adjuvant nivolumab. Median follow-up= 21 months (range 10–40); 77.8% remain disease-free. 4 relapsed (1 local, 3 systemic); 3 have died. Conclusions NACRT is effective and well tolerated in selected older patients, with toxicity and early survival outcomes comparable to those reported in the CROSS trial. These results support its use as part of a radical treatment strategy in appropriate cases.