Management of esogastric cancer in older patients

Author:

Aparicio Thomas1ORCID,Carteaux-Taieb Anna2,Arégui Amélie3ORCID,Estrada Janina4,Beraud-Chaulet Geoffroy5,Fossey-Diaz Virginie3,Hammel Pascal5ORCID,Cattan Pierre2

Affiliation:

1. Gastroenterology Department, Saint Louis Hospital, APHP, Université Paris Cité, 1 Avenue Claude Vellefaux, Paris 75475, France

2. Department of Digestive Surgery, Saint Louis Hospital, APHP, Université Paris Cité, Paris, France

3. Paris Nord Oncogeriatrics Coordination Unit, Bretonneau Hospital, APHP, Paris, France

4. Geriatric Out-Patient Unit, Bretonneau Hospital, APHP, Paris, France

5. Digestive and Medical Oncology Department, Paul Brousse Hospital, APHP, Paris-Saclay University, Villejuif, France

Abstract

Although esogastric cancers often affect patients over 75, there are no specific age-related guidelines for the care of these patients. Esogastric cancers have a poor prognosis and require multimodal treatment to obtain a cure. The morbidity and mortality of these multimodal treatments can be limited if care is optimized by selecting patients for neoadjuvant treatment and surgery. This can include a geriatric assessment, prehabilitation, renutrition, and more extensive use of minimally invasive surgery. Denutrition is frequent in these patients and is particularly harmful in older patients. While older patients may be provided with neoadjuvant chemotherapy or radiotherapy, it must be adapted to the patient’s status. A reduction in the initial dose of palliative chemotherapy should be considered in patients with metastases. These patients tolerate immunotherapy better than systemic chemotherapy, and a strategy to replace chemotherapy with immunotherapy whenever possible should be evaluated. Finally, better supportive care is needed in patients with a poor performance status. Prospective studies are needed to improve the care and prognosis of elderly patients.

Publisher

SAGE Publications

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