Definitive Chemoradiotherapy for Older Patients With Esophageal Cancer—Reply

In Reply We would like to thank Kashihara and colleagues and Hayashi and colleagues for their comments on our phase 3 randomized clinical trial of concurrent chemoradiotherapy (CCRT) with S-1 vs radiotherapy (RT) alone for older patients with esophageal cancer.¹ Hayashi and colleagues addressed that the standard treatment in this population may not be RT alone, but CCRT. Indeed, the RTOG 8501 trial² showed that CCRT with fluorouracil/cisplatin (FP) was superior to RT alone. However, as the toxic effects of CCRT were substantial and patients 70 years or older accounted for only 23% in this trial, it does not mean that CCRT has become the standard treatment for older patients.² In fact, most older patients cannot complete the standard CCRT with FP. A nationwide study from the Netherlands showed that less than 15% of patients 75 years or older received CCRT.³