Comparative study of radiotherapy plus erlotinib versus chemoradiotherapy for elderly patients with esophageal cancer: a propensity score-matched analysis

This study compared the efficiency and safety of radiotherapy plus erlotinib with concurrent chemoradiotherapy (CCRT) based on paclitaxel plus cisplatin in elderly esophageal cancer patients. The eligible patients were retrospectively enrolled at Wenzhou Medical University cancer center from January 2005 to December 2011. Propensity score matching generated a matched cohort (1:1) composed from radiotherapy plus erlotinib and CCRT groups. The efficiency and safety were compared between two groups. Multivariable analysis was used to identify significant prognostic factors. Thirty-four patients treated with radiotherapy plus erlotinib were matched with patients who received CCRT. Radiotherapy plus erlotinib group showed better treatment compliance compared with the CCRT group (91.2% vs. 67.6%, hazard ratio [HR] 0.202, 95% confidence interval [CI] 0.051–0.809; P = .016). No significant overall response rate differences were found between the two groups (88.2% vs. 79.4%, HR 0.514, 95% CI 0.135–1.952; P = .323). The 5-year overall survival (OS) rate was 23.5% vs. 19.2% for patients treated with CCRT or radiotherapy plus erlotinib (HR 1.008, 95% CI 0.574–1.768; P = .979). The 5-year progression-free survival (PFS) rate was 16.8% versus 17.1% for patients treated with CCRT or radiotherapy plus erlotinib, respectively (HR 0.978, 95% CI 0.576–1.662; P = .934). The rate of severe hematologic toxicities in the CCRT group was significantly higher than that in the radiotherapy plus erlotinib group (HR 4.306, 95% CI 1.066–17.389; P = .031). Late toxicities were similar between radiotherapy plus erlotinib group and the CCRT group. Multivariate analysis showed that T stage (HR 1.730, 95% CI 1.062–2.816; P = .028), M stage (HR 2.859, 95% CI 1.407–5.811; P = .004), and complete response (HR 2.154, 95% CI 1.190-3.901; P = .011) were independent prognostic factors associated with OS. In conclusion, the present study suggested radiotherapy plus erlotinib should be a preferable modality compared with CCRT, with similar survival outcomes but better treatment compliance and less toxicities.