The Uptake and Efficacy of Neoadjuvant Therapy in Older Adults with Locally Advanced Esophogastric Cancer



Data on Neo+/− adjuvant treatment in older patients with cancer is sparse. The management of locally advanced esophagogastric cancer (LAEC) in older patients was evaluated to determine treatment modalities and identify factors associated with survival.


Patients diagnosed with LAEC (stage II or III) over 5 years were identified from the National Cancer Registry of Ireland. Treatment was classified as “best supportive care (BSC),” “surgery only,” “neo/adjuvant treatment,” and “chemo/radiation alone.”Survival was assessed. Univariate and multivariate analysis (MVA) of clinicopathological factors and treatment was conducted.


Forty-six percent (n = 580) of the 1251 patients were ≥ 70 years, 11% (n = 134) received BSC, 23% (n = 288) surgery only, 31% (n = 390) had chemo/radiation alone, and 35% (n = 439) had neo/adjuvant treatment. Forty-six percent, 10%, and 0% of patients < 75, ≥ 75, and ≥ 80 years of age, respectively, received neoadjuvant treatment. Age was associated with treatment received (p < 0.001). Older patients were less likely to receive neo/adjuvant treatment, surgery, and any treatment. Median survival (OS) decreased with age (< 70 years: 23 months; 70–74: 19 months; 75–79: 13 months; ≥ 80 years: 10 months). In MVA, older age, smoking, later stage, and higher grade were significantly associated with a higher risk of death. Patients receiving neo/adjuvant treatment had lower risk of death than any other treatment group regardless of age.


Older patients were less likely to receive treatment for LAEC than younger patients. Patients aged ≥ 70 years benefit from neo/adjuvant treatment. Prospective clinical trials focusing on older patients and incorporating life expectancy, comorbidities, and geriatric assessment are needed to guide treatment.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Liu H-C, Chen Y-C, Chen C-H, et al. Esophagectomy in elderly patients with esophageal cancer. Int J Gerontol. 2010;4:176e179.

    Google Scholar 

  2. 2.

    Won E, Ilson DH. Management of localized esophageal cancer in the older patient. Oncologist. 2014;19:367–74.

    Article  Google Scholar 

  3. 3.

    Steyerberg EW, Neville B, Weeks JC, Earle CC. Referral patterns, treatment choices, and outcomes in locoregional esophageal cancer: a population-based analysis of elderly patients. J Clin Oncol. 2007;25:2389–96.

    Article  Google Scholar 

  4. 4.

    Molena D, Stem M, Blackford AL, Lidor AO. Esophageal cancer treatment is underutilized among elderly patients in the USA. J Gastrointest Surg. 2017;21:126–36.

    Article  Google Scholar 

  5. 5.

    Cunningham D, Allum WH, Stenning SP, Thompson JN, van de Velde C, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20.

    CAS  Article  Google Scholar 

  6. 6.

    Ychou M, Boige V, Pignon J-P, et al. Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. J Clin Oncol. 2011;29:1715–21.

    CAS  Article  Google Scholar 

  7. 7.

    Al-Batran S, et al. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): a multicenter, randomized phase 3 trial. J Clin Oncol. 2017;35:4004.

    Article  Google Scholar 

  8. 8.

    Shapiro J, van Lanschot JJB, Hulshof MC, van Hagen P, van Berge Henegouwen M, Wijnhoven BPL, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol. 2015;16:1090–8.

    Article  Google Scholar 

  9. 9.

    Allum WH, Stenning SP, Bancewicz J, et al. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol. 2009;27:5062–7.

    Article  Google Scholar 

  10. 10.

    Medical Research Council Oesophageal Cancer Working Group Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 2002;359:1727–33.

  11. 11.

    Sjoquist KM, Burmeister BH, Smithers BM, et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.

    Article  Google Scholar 

  12. 12.

    Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Perioperative chemo(radio)therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus. Cochrane Database Syst Rev. 2013;5:CD008107.

    Google Scholar 

  13. 13.

    Hurria A, Lichtman SM. Clinical pharmacology of cancer therapies in older adults. Br J Cancer. 2008;98:517–22.

    CAS  Article  Google Scholar 

  14. 14.

    Al-Batran SE, Pauligk C, Homann N, Hartmann JT, Moehler M, Probst S, et al. The feasibility of triple-drug chemotherapy combination in older adult patients with oesophagogastric cancer: a randomised trial of the Arbeitsgemeinschaft Internistische Onkologie (FLOT65+). Eur J Cancer. 2013;49:835–42.

    Article  Google Scholar 

  15. 15.

    Bollschweiler E, Plum P, Mönig SP, et al. Current and future treatment options for esophageal cancer in the elderly. Expert Opin Pharmacother. 2017;18:1001–10.

    CAS  Article  Google Scholar 

  16. 16.

    Sylvie L, Silvia S, Salah-Eddin AB, Markus F, Florian L, Peter TP, et al. Impact of age on the feasibility and efficacy of neoadjuvant chemotherapy in patients with locally advanced oesophagogastric cancer. Eur J Cancer. 2015;51:1918–26.

    CAS  Article  Google Scholar 

  17. 17.

    Hall PS, Swinson D, Waters JS, et al. Optimizing chemotherapy for frail and elderly patients with advanced gastroesophageal cancer: the GO2 phase III trial. 2019 ASCO Annual Meeting. Abstract 4006.

  18. 18.

    Ruol A, Portale G, Zaninotto G, Cagol M, Cavallin F, Castoro C, et al. Results of esophagectomy for esophageal cancer in elderly patients: age has little influence on outcome and survival. J Thorac Cardiovasc Surg. 2007;133:1186–92.

    Article  Google Scholar 

  19. 19.

    Liu H-C, Huang W-C, Chen C-H, et al. Radical esophagectomy in elderly patients with esophageal cancer. Formosan J Surg. 2015;48:121–7.

    Article  Google Scholar 

  20. 20.

    Revels SL, Morris AM, Reddy RM, Akateh C, Wong SL. Racial disparities in esophageal cancer outcomes. Ann Surg Oncol. 2013;20:1136–41.

    Article  Google Scholar 

  21. 21.

    Lineback CM, Mervak CM, Revels SL, Kemp MT, Reddy RM. Barriers to accessing optimal esophageal cancer care for socioeconomically disadvantaged patients. Ann Thorac Surg. 2017;103:416–21.

    Article  Google Scholar 

  22. 22.

    Kim HS, Kim JH, Kim JW, et al. Chemotherapy in elderly patients with gastric cancer. J Cancer. 2016;7:88–94.

    CAS  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Petra Martin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(XLSX 16 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Martin, P., O’Leary, E., Deady, S. et al. The Uptake and Efficacy of Neoadjuvant Therapy in Older Adults with Locally Advanced Esophogastric Cancer. J Gastrointest Canc 51, 893–900 (2020).

Download citation


  • Esophageal
  • Gastric
  • Cancer
  • Older
  • Survival
  • Neoadjuvant