Feasibility and treatment outcomes of simultaneous definitive chemoradiotherapy for elderly patients with synchronous hypopharyngeal and esophageal squamous cell carcinoma

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Hypopharyngeal and esophageal squamous cell carcinoma may occur synchronously; however, optimal treatment strategies, particularly for elderly patients, remain undefined. We evaluated the feasibility and outcomes of simultaneous definitive chemoradiotherapy in this population. This single-institution retrospective study included patients aged ≥65 years who received definitive chemoradiotherapy for synchronous hypopharyngeal and esophageal squamous cell carcinomas between January 2002 and December 2022. Definitive chemoradiotherapy completion rate, objective response, overall survival, progression-free survival and adverse events were assessed. Fifteen patients were included (median age, 71 years; range, 67-85); all patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The clinical stages of the carcinomas ranged from early to locally advanced, with the hypopharynx being the advanced site in seven patients (47%), the esophagus in six (40%) and both sites equally in two (13%). The definitive chemoradiotherapy regimen comprised three-dimensional conformal radiotherapy with 70 Gy in 35 fractions for hypopharyngeal carcinomas and 60 Gy in 30 fractions for esophageal carcinomas, with concurrent systemic chemotherapy, the most common being cisplatin/fluorouracil (seven patients, 47%). All patients completed the planned radiotherapy; although six patients (40%) required temporary radiotherapy suspension. Thirteen patients (87%) completed the planned chemotherapy. All patients achieved complete or partial response. The 2-year overall survival and progression-free survival rates were both 56%. All patients experienced grade ≥ 2 adverse events, but they were tolerable. Simultaneous definitive chemoradiotherapy is feasible and demonstrates favorable outcomes for elderly patients with synchronous hypopharyngeal and esophageal squamous cell carcinomas.

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