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Comment & Response
December 30, 2021

Definitive Chemoradiotherapy for Older Patients With Esophageal Cancer—Reply

Author Affiliations
  • 1Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
  • 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
JAMA Oncol. 2022;8(2):305-306. doi:10.1001/jamaoncol.2021.6843

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

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