Treatment of esophageal cancer in inoperable elderly patients: our experience

Patients and methods During the 1997–2007 decade, 57 cases of esophageal neoplasm were observed, of which 15 patients whose age range was 70–85 years, 11 males and 4 females, all presented with associated cardiovascular, respiratory and metabolic pathologies that would not allow the possibility of surgical approach. Patients enrolled in the current study contain in their clinical history several risk factors, and more precisely: Barrett's esophagus 2, Achalasia 3, Reflux esophagitis 5. Two out of 15 patients were alcoholdependent, whereas 11/15 were heavy smokers. All patients presented serious nutritional deficits. Diagnosis was made after symptoms of dysphagia manifested, after having undergone an endoscopic examination and biopsy. Clinical staging provided for the ultrasound examination and thoracic-abdominal CT. The neoplasias were located 12 in the cardiac region, 1 in the medio-thoracic region, 2 in the cervical tract. There were 5 carcinomas in situ, 4 infiltrating adenocarcinomas, 6 squamous cell carcinomas of which 3 stenosed, 2 ulcerated, 1 vegetative. Hepatic metastasis was present in 8 out of the 15 cases, lymphonodal and mediastinic in 2 cases. An endoscopic mucosectomy was performed in the 5 patients affected by carcinomas in situ. In the 3 patients affected with stenosed squamous cell carcinomas, a series of dilations and prosthetic nitinol stent positioning (Boston Scientifics) were undertaken in order to restore the passage as much as possible. The four infiltrating and metastatic adenocarcinomas were treated with chemotherapy cycles. A case of a vegetative tumor with hepatic metastasis was treated with Bicap use (monopolar electrode), with thermal destruction of the neoplastic tissue, and followed by a series of treatment cycles undertaken to eradicate it. The remaining two ulcerated cases were treated with Argon plasma coagulator.