• ESCC
• SOCS6
• hypoxia relief
• radiosensitization
• virus‐inspired nanoparticles

• Humans
• Radiation-Sensitizing Agents/chemistry
• Radiation-Sensitizing Agents/pharmacology
• Esophageal Squamous Cell Carcinoma/metabolism
• Esophageal Squamous Cell Carcinoma/radiotherapy
• Esophageal Squamous Cell Carcinoma/pathology
• Cell Line, Tumor
• Animals
• Oxides/chemistry
• Suppressor of Cytokine Signaling Proteins/metabolism
• Esophageal Neoplasms/metabolism
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/radiotherapy
• Mice
• Metal Nanoparticles/chemistry
• Manganese/chemistry
• Mice, Nude
• Nanoparticles/chemistry
• Mice, Inbred BALB C

• 82272941 National Natural Science Foundation of China
• 2021JM-245 Natural Science Foundation of Shaanxi Province

• Chemoradiotherapy
• Elderly
• Esophageal cancer
• Meta-analysis
• Surgery

• Humans
• Esophageal Neoplasms/therapy
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Aged
• Neoadjuvant Therapy/methods
• Chemoradiotherapy/methods
• Aged, 80 and over
• Esophagectomy
• Male

• chemotherapy
• esophagus cancer
• gastric cancer
• geriatric evaluation
• older patients
• surgery

• chemoradiation
• elderly patients
• esophageal cancer
• radiotherapy
• squamous cell cancer

Present studies on the efficacy and safety of curative chemoradiation therapy (CRT) with esophageal cancer reflect heterogenous results especially in elderly patients. The aim of this study was to evaluate the toxicity and efficacy of CRT in patients ≥ 65 years. In a cohort, the focus centered around treatment-related toxicity (CTCAE Grade > 3), overall survival as well as progression free survival, comparing these rates in-between patients older than 70 years to those younger than 70 years.

A total of 67 patients older than 65 years (34 (50.7%) were older than 70 years) met the inclusion criteria for retrospective analysis (period from January 2013 to October 2017). Treatment consisted of radiotherapy and chemotherapy with carboplatin/paclitaxel or fluorouracil (5-FU)/cisplatin with the intention of neoadjuvant or definite chemoradiation. A sum of 67 patients received CRT (44 (65.6%) patients in neoadjuvant, 23 (34.4%) in definite intent). Of these, 22 and 12 patients were older than 70 years (50% and 52.2% in both treatment groups, respectively). Median age was 71 years and patients had a good physical performance status (ECOG 0: 57.6%, ECOG 1: 27.3%). Median follow-up was 24 months. Most patients had advanced tumour stages (T3 stage: n = 51, 79.7%) and nodal metastasis (N1 stage: n = 54, 88.5%). A subgroup comparison was conducted between patients aged ≤ 70 years and > 70 years.

In severe (CTCAE Grade 3–5) toxicities (acute and late), no significant differences were observed between both patient groups (< 70 years vs. > 70 years). 21% had acute grade 3 events, 4 patients (4%) had grade 4 events, and two patients (3%) had one grade 5 event. Late toxicity after CRT was grade 1 in 13 patients (22%), grade 2 in two (3%), grade 3 in two (3%), grade 4 in four (7%), and grade 5 in one (2%). Median overall survival (OS) of all patients was 30 months and median progression-free survival (PFS) was 16 months. No significant differences were seen for OS (32 months vs. 25 months; p = 0.632) and PFS (16 months vs. 12 months; p = 0.696) between older patients treated with curative intent and younger ones. Trimodal therapy significantly prolonged both OS and PFS (p = 0.005; p = 0.018), regardless of age.

CRT in elderly patients (≥ 65 years) with esophageal cancer is feasible and effective. Numbers for acute and late toxicities can be compared to cohorts of younger patients (< 65 years) with EC who received the same therapies. Age at treatment initiation alone should not be the determining factor. Instead, functional status, risk of treatment-related morbidities, life expectancy and patient´s preferences should factor into the choice of therapy.

• carcinoma
• esophageal cancer
• chemoradiation
• elderly
• toxicity

• Brachytherapy
• Esophageal neoplasms
• Radiotherapy
• Systematic review

• chemoradiotherapy
• esophageal cancer
• esophagectomy
• geriatric oncology
• radiotherapy

• Aged
• Carcinoma, Squamous Cell/pathology
• Chemoradiotherapy
• Epithelial Cells/pathology
• Esophageal Neoplasms/pathology
• Esophageal Squamous Cell Carcinoma/surgery
• Esophagectomy
• Humans
• Prospective Studies
• Treatment Outcome

• Chugai Pharmaceutical Company, Ltd
• Taiho Pharmaceutical Company, Ltd
• Fujifilm, Toyama Chemical Company, Ltd
• Abbott Japan Company, Ltd
• KCI Licensing, Inc
• Tsumura & Company, Ltd
• Sanofi K.K., Eisai Company, Ltd
• Japan Blood Products Organization Medtronic Japan Company, Ltd
• Nihon Pharmaceutical Company, Ltd
• Ono Pharmaceutical Company, Ltd
• Pfizer Japan, Inc
• Kyouwa Hakkou Kirin Company, Ltd
• Taisho Toyama Pharmaceutical Company, Ltd
• Dainippon Sumitomo Pharma Company, Ltd
• Medicon, Inc
• Astellas Pharma, Inc
• Kowa Pharmaceutical Company, Ltd
• Kaken Pharmaceutical Company, Ltd
• Shionogi Company, Ltd
• Otsuka Pharmaceutical Factory, Inc
• Takeda Pharmaceutical Company, Ltd
• Otsuka Pharmaceutical Company, Ltd
• EA Pharma Company, Ltd
• Asahi Kasei Company, Ltd
• Merck Serono Company, Ltd
• Daiichi Sankyo Company, Ltd
• Yakult Honsha Company, Ltd
• Nihon Pharmaceutical Co, Ltd
• Ono Pharmaceutical Company
• Taisho Toyama Pharmaceutical Company

It is estimated that about 30% of esophageal cancer (EC) patients are over 70 years old. Therefore, there is less evidence on the diagnosis and management of elderly EC patients. It is important to explore how elderly EC patients benefit from radical radiochemotherapy regimens, including the target area of radiotherapy (RT), radiation dose and fraction, and choice of chemotherapy drugs.

To compare the efficacy of involved-field intensity-modulated RT (IF-IMRT) combined with S-1 vs RT alone in the treatment of elderly EC patients in terms of safety, short-term response, and survival.

Thirty-four EC patients aged > 70 years were prospectively enrolled between December 2017 and December 2019. Based on the random number table, they were divided into an IF-IMRT + S-1 group and an IF-IMRT alone group, with 17 patients in each group. All patients were treated with IF-IMRT at a dose of 50.4-56 Gy in 28-30 fractions (1.8-2 Gy/fraction, 5 fractions/wk). Oral S-1 was administered concomitantly in the IF-IMRT + S-1 group for 14 consecutive days, and a second cycle was started 7 d after drug withdrawal. After RT, 4 cycles of S-1 treatment were offered as the consolidation chemotherapy. The safety, short-term response, and survival were observed after the treatment.

As of April 2022, these 34 patients had been followed up for 15.2-32.5 mo, with a median follow-up period of 24.5 mo. Complete efficacy indicators were obtained from all the patients. The objective response rate was 88.2% vs 76.5%, respectively, in the IF-IMRT + S-1 group and the RT alone group, where as the disease control rate was 100% vs 82.4%, respectively. The incidence of adverse events including grade 1-2 fatigue, granulocytopenia, thrombocytopenia, anemia, radiation esophagitis, radiation-induced skin injury, and radiation-induced lung injury was not significantly different between these two groups, so was the incidence of the grade 3 radiation esophagitis (0% vs 5.7%). The rate of progressive disease (PD) was 52.9% (n = 9) in the IF-IMRT + S-1 group and 64.7% (n = 11) in the RT alone group. The median progression-free survival (PFS) was 23.4 mo vs 16.3 mo, and the 2-year PFS rate was 42% vs 41.2%. The median overall survival (OS) was 27.0 mo vs 23.0 mo, and the 2-year OS rate was 58.8% vs 47.1%. Multivariate analysis showed that age was a significant prognostic factor (P = 0.0019); patients aged < 75 years had a significant survival advantage over patients aged ≥ 75 years. The locations of EC also affected the prognosis. In the IF-IMRT + S-1 group, the number of chemotherapy cycles was a significant prognostic factor (P = 0.0125), and the risk of PD was significantly lower in EC patients who had received 6 cycles of chemotherapy than those who had received 2-5 cycles of chemotherapy.

Compared with IF-IMRT alone, IF-IMRT + S-1 shows the benefits of preventing PD and prolonging survival without increasing adverse reactions. Therefore, this concurrent radiochemotherapy deserves clinical application.

• Elderly patients
• Esophageal cancer
• Involved-field radiation therapy
• S-1
• Chemotherapy

• Chemoradiotherapy
• Chimioradiothérapie
• Elderly patients
• Esophageal neoplasms
• Patients âgés
• Prognosis
• Pronostic
• S1
• Tumeurs de l’œsophage

• Computed Tomography
• Deep learning
• Esophageal squamous cell cancer
• Local recurrence-free survival
• Radiomics

• Autopsy
• Chemoradiotherapy
• Esophageal squamous cell carcinoma
• Medical oncology
• S-1

The optimal evidence-based management for the subsets of locally advanced esophageal squamous cell carcinoma (ESCC) patients who rejected or were intolerant to intravenous chemotherapy due to old age or serious comorbidities is currently lacking. This study aimed to assess the safety and local control rate (LCR) of S-1 (tegafur–gimeracil–oteracil potassium) combined with radiotherapy in these subsets of ESCC patients.

Locally advanced ESCC patients who rejected or were intolerant to intravenous chemotherapy due to age >75 years or serious comorbidities were enrolled in a prospective, single-arm, phase 2 trial. The patients were treated with definitive concurrent chemoradiotherapy with S-1, which was administered orally twice daily for 28 days. The radiotherapy dose was 61.2 Gy delivered in 34 fractions. The primary end-point was the 3-year LCR.

One hundred five ESCC patients were recruited between March 2013 and October 2015. At the median follow-up of 73.1 months (IQR 65.5–81.4 months), 3-year LCR was 61.1%, and 1, 3, and 5-year overall survival was 77.9, 42.3, and 24.8% respectively. For safety analysis, ≥grade 3 acute adverse events included thrombocytopenia (6.7%), leukopenia (2.9%), anemia (1.0%), anorexia (1.0%), fatigue (10.5%), hiccup (1.0%), pneumonitis (4.8%), and esophagitis (3.8%). Two patients (1.9%) died of late esophageal hemorrhage, and one patient (1.0%) died of late radiation-induced pneumonitis.

S-1 is a promising regimen in concurrent chemoradiotherapy with low toxicity and a favorable LCR in ESCC patients who rejected or were intolerant to intravenous chemotherapy due to old age or serious comorbidities.

ClinicalTrials.gov, NCT01831531.

• S-1
• definitive chemoradiotherapy
• elderly
• esophageal squamous cell carcinoma
• serious comorbidities

• S-1
• concurrent chemoradiotherapy
• efficacy
• elderly patients
• esophageal squamous cell carcinoma
• safety

The proportion of elderly patients with esophageal cancer (EC) is increasing due to prolonged life expectancy and aging process. The aim of the study is to explore the optimal treatment strategy for elderly patients (aged ≥70 years) with locally advanced EC.

Eligible patients with cT2-4aNxM0 EC were identified in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. Treatment patterns were divided into six groups: surgical resection (S), chemoradiotherapy (CRT), trimodality therapy (CRT+S), radiotherapy (RT), chemotherapy (CT), or observation with no treatment (Obs). Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS).

A total of 2917 patients with potentially curable EC were identified. Of all the patients included, 6.7%, 51.8%, 18.0%, 9.4% and 3.6%received S, CRT, CRT+S, RT, and CT, respectively, whereas 10.6% underwent Obs. The 3-year OS estimates were 30.2% (95% confidence interval [CI]: 23.5–38.9%), 25.4% (95% CI: 22.8–28.3%),44.3% (95% CI: 39.3–49.9%), 11.4% (95% CI: 7.7–17.0%), 16.1% (95% CI: 9.1–28.3%), and 5.6% (95% CI: 3.2–9.8%) for S, CRT, CRT+S RT, CT, and Obs (p<0.001), respectively. Overall, patents underwent CRT+S had the longest OS, compared to other treatment patterns, and the survival difference was not significant between patients receiving CRT and S (p=0.12) in the elderly population. However, the survival benefits of trimodality therapy over CRT gradually weakened with the increase in age, and became statistically non-significant for EC patients aged ≥80 years (p=0.35). Multivariate analysis showed that treatment patterns, age, sex, tumor grade, T stage, N stage, and marital status were significantly associated with OS.

Generally, the use of trimodality therapy was associated with the longest OS, the survival benefits were comparable between CRT and S alone, and CRT was superior to RT or CT alone in elderly patients with curable EC. For patients intolerable to surgery or aged ≥80 years, definitive CRT should be considered as a preferable option.

• Esophageal squamous cell carcinoma (ESCC)
• elderly
• prognostic nutritional index (PNI)
• radiotherapy
• systemic inflammation response index (SIRI)

There is still no definitely therapeutic evidence of a beneficial effect of chemotherapy with radiotherapy for older patients with esophageal squamous cell carcinoma (ESCC). We aim to determine the influence of chemoradiotherapy (CRT) and radiotherapy (RT) alone in patients aged 65 years or older with locally advanced ESCC.

We retrospectively analyzed 581 ESCC patients who underwent CRT and RT alone. Univariate and multivariate Cox regression analysis was used to analyze the impact of clinical factors on long‐term overall survival (OS) and progression-free survival (PFS). Finally, we compared the toxicity rates of these patients.

The median OS and PFS of the overall population were 23.2 months (2.0–162.6 months) and 18.6 months (1.1–159.6 months). Multivariate Cox regression analysis showed that chemotherapy (p < 0.05), tumor thickness (p < 0.01), and N stage (p < 0.05) were independent prognostic factors associated with both OS and PFS. In the chemotherapy subgroup, patients who received 2–8 cycles of chemotherapy had better OS than those who received 1 cycle (p = 0.015). The results also revealed that the CRT group has better OS and PFS than RT alone group for patients aged 65–74 years (both p < 0.01). However, for patients aged 75 years or older, there was no statistically significant difference between CRT and RT alone (both p > 0.05). Besides, higher staged ESCC has the inferior OS and PFS than lower staged ESCC for patients received RT alone and aged 65–74 years (both p < 0.05). Finally, there were significantly more severe hematologic toxicities in the CRT group than in those treated with RT alone in this study (p < 0.001).

The present study suggested that CRT for locally advanced ESCC in patients aged 65 years or older had a significant benefit over RT alone in terms of OS and PFS. However, for patients aged 75 years or older, there was no statistically significant difference between CRT and RT alone. CRT should be performed with special attention in patients aged 75 years or older.

• Chemoradiotherapy
• Esophageal squamous cell carcinoma
• Overall survival
• Progression-free survival
• Radiotherapy

Radiotherapy (RT) is the main treatment for unoperated esophageal cancer (EC) patients. It is controversial whether adding chemotherapy (CT) to RT is beneficial for elderly EC patients. The purpose of our study was to compare the efficacy of chemoradiotherapy (CRT) with RT alone for non-surgical elderly esophageal cancer patients.

A total of 7,101 eligible EC patients older than 65 years diagnosed between 2000 and 2018 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. All the samples were divided into the radiotherapy group and the chemoradiotherapy group. After being matched by propensity score matching (PSM) at a 1:1 ratio, 3,020 patients were included in our analysis. The Kaplan–Meier method and log-rank test were applied to compare overall survival (OS) and cancer-specific survival (CSS).

After PSM, the clinical characteristics of patients between the RT and CRT groups were comparable. For EC patients older than 65 years, the 3-year OS and CSS in the CRT group were 21.8% and 27.4%, and the 5-year OS and CSS in the CRT group were 12.7% and 19.8%, respectively. The 3-year OS and CSS in the RT group were 6.4% and 10.4%, and the 5-year OS and CSS in the RT group were 3.5% and 7.2%, respectively. Next, these patients were divided into five subgroups based on the age stratification (ages 65–69; 70–74; 75–79; 80–84; ≥85). In each subgroup analysis, the 3- and 5-year OS and CSS showed significant benefits in the CRT group rather than in the RT group (all p < 0.05). We were unable to assess toxicities between the two groups due to a lack of correlated information.

CRT could improve OS and CSS for non-surgical EC patients older than 65 years. Adding chemotherapy to radiation showed a significant prognostic advantage for elderly esophageal cancer patients.

• SEER
• chemoradiation
• elderly patients
• esophageal cancer
• survival analysis

• SIB-IMRT
• esophageal neoplasm
• intensity-modulated radiotherapy
• prognosis

• Chemoradiation
• Esophageal cancer
• IMRT
• Simultaneous integrated boost

• Adult
• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Chemoradiotherapy/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/therapy
• Esophageal Squamous Cell Carcinoma/pathology
• Esophageal Squamous Cell Carcinoma/therapy
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local/pathology
• Neoplasm Recurrence, Local/therapy
• Prognosis
• Radiotherapy, Intensity-Modulated/mortality
• Retrospective Studies
• Survival Rate

• Projekt DEAL

To investigate the safety and efficacy of nimotuzumab combined with radiotherapy for elderly patients with non-resectable esophageal carcinoma (EC).

Eligible patients were aged 70 years or older and had treatment-naïve, histologically proven inoperable locally advanced EC. Enrolled patients received radiotherapy with a total dose of 50−60 Gy in 25−30 fractions, concurrent with weekly infusion of nimotuzumab. The primary end point was the rate of more than grade 3 toxicities.

From June 2011 to July 2016, 46 patients with stage II−IV EC with a median age of 76.5 years were enrolled. There were 10, 28 and 8 patients with stage II, III and IV disease, respectively. The common acute toxicities included esophagitis (grade 1−2, 75.4%; grade 3, 8.7%), pneumonitis (grade 1, 4.3%; grade 2, 6.5%; grade 3, 2.2%), leukopenia (grade 1−2, 60.9%; grade 3−4, 4.4%), gastrointestinal reaction (grade 1−2, 17.3%; grade 3, 2.2%), thrombocytopenia (grade 1−2, 21.7%; grade 3, 2.2%), and radiothermitis (grade 1−2, 39.2%). The incidence of grade 3−4 adverse effects was 17.4%. No grade 5 toxicities were observed. Clinical complete response, partial response, stable disease, and progressive disease were observed in 1 (2.2%), 31 (67.4%), 12 (26.1%), and 2 (4.3%) patients, respectively. The median overall survival (OS) and progression-free survival (PFS) were 17 and 10 months, respectively. The 2-, 3-, and 5-year OS and PFS rates were 30.4%, 21.7%, 19.6%, and 26.1%, 19.6%, 19.6%, respectively.

Nimotuzumab combined with radiotherapy is a safe and effective therapy for elderly patients who are not surgical candidates. Further studies are warranted to confirm its therapeutic effects in elderly EC patients.

• Nimotuzumab
• elderly
• esophageal neoplasm
• radiotherapy
• treatment outcome

• Concurrent chemoradiotherapy
• Elderly
• Esophageal squamous cell carcinoma
• Survival

• Aged
• Chemoradiotherapy
• Combined Modality Therapy
• Comorbidity
• Esophageal Squamous Cell Carcinoma/diagnosis
• Esophageal Squamous Cell Carcinoma/mortality
• Esophageal Squamous Cell Carcinoma/therapy
• Female
• Humans
• Male
• Neoplasm Staging
• Prognosis
• Treatment Outcome

• 2016-ZQN-32 Fujian Provincial Health & Family Planning Commission(CN)
• 2018J01306 Fujian Provincial Department of Science and Technology
• 2017Y9079 Fujian Provincial Department of Science and Technology
• FYKFKT- 2017015 Fujian Provincial Platform for Medical Laboratory Research, and Key Laboratory for Tumor Individualized Active Immunity
• Fujian Provincial Health & Family Planning Commission(CN)

• Esophageal cancer
• chemoradiation
• elective nodal irradiation
• involved field radiation therapy
• older patients
• radiotherapy

• Age Factors
• Aged
• Aged, 80 and over
• Combined Modality Therapy
• Esophageal Neoplasms/mortality
• Esophageal Neoplasms/pathology
• Esophageal Neoplasms/radiotherapy
• Female
• Follow-Up Studies
• Humans
• Male
• Medication Adherence
• Neoplasm Staging
• Radiotherapy, Image-Guided/adverse effects
• Radiotherapy, Image-Guided/methods
• Survival Analysis
• Treatment Outcome

• Clinical
• Esophageal squamous cell carcinoma
• Esophagus
• Mouse models
• Pathogenesis
• Therapy
• Translational

• Animals
• Biomarkers, Tumor/genetics
• Disease Management
• Disease Models, Animal
• Disease Progression
• Esophageal Neoplasms/diagnosis
• Esophageal Neoplasms/genetics
• Esophageal Neoplasms/therapy
• Esophageal Squamous Cell Carcinoma/diagnosis
• Esophageal Squamous Cell Carcinoma/genetics
• Esophageal Squamous Cell Carcinoma/therapy
• Humans
• Risk Factors

• K01 DK103953 NIDDK NIH HHS
• R03 DK118304 NIDDK NIH HHS

The aim of this study was to review the published literature addressing the question of whether geriatric assessment (GA) should be routinely applied in the treatment of older adults with esophageal cancer (EC) who have received definitive concurrent chemoradiotherapy (dCRT).

A literature search of PubMed, Embase, and Cochrane Library was performed. Studies that contained original data outlining the inclusion and exclusion criteria, treatment compliance rate, and severe toxicity reports were reviewed. Additionally, criteria from ongoing clinical trials in the World Health Organization and National Institutes of Health registries were reviewed to evaluate the utilization of GA-related domains in elderly EC patients who received dCRT.

Twenty-nine studies were identified based on the selection criteria: five were single-arm prospective studies, and the other studies were retrospective studies. All studies used chronological age and performance status as basic descriptors for this subpopulation. The comorbidity index and the malnutrition level were mentioned in several studies. However, factors such as “Demographic data and social support,” “Psychology,” “Polypharmacy,” and “Geriatric syndromes” were not described in any of the included studies. Unfortunately, the results were similar for the registered clinical trials. Finally, treatment compliance and toxicity profile were found to be acceptable in selected elderly EC patients.

The current experience for older adults with EC receiving dCRT is mainly based on the results of a series of retrospective studies. Ongoing clinical trials should routinely consider GA-related domains to select appropriate treatments for patients in the future.

• chemoradiotherapy
• esophageal cancer
• geriatric assessment
• inclusion criteria
• older adults
• toxicity

• Chemoradiation
• Elderly
• Esophageal cancer

Because of the exclusion for the patients more than 75 years (very elderly patients) in many clinical trials of esophageal cancer (EC), there is no consensus on prognosis and treatment for this population. We aim to evaluate the outcomes and aging‐related prognostic factors of definitive radiotherapy (RT) for very elderly EC patients. We retrospectively analyzed 149 very elderly EC patients consecutively treated between January 2015 and June 2016 by definitive intensity‐modulated radiotherapy (IMRT) with or without chemotherapy. The clinical outcome and toxicities were assessed, and the potential prognostic factors, such as nutritional risk index (NRI) and neutrophil–lymphocyte ratio (NLR), were analyzed statistically. The median follow‐up time for survivors was 22.5 months. The 2‐year overall survival (OS), local–regional failure‐free survival (LRFFS), and distant metastasis‐free survival (DMFS) were 51.6%, 54.7%, and 85.2%, respectively. Independent predictors for poorer OS were higher American Joint Committee on Cancer (AJCC) stage, lower NRI, and higher NLR value before RT. Meanwhile, the total dose (cutoff value 60 Gy) of planning gross tumor volume (PGTV) and chemotherapy was also identified as independent prognostic indicator for LRFFS and DMFS, respectively. 72 patients had treatment failure and 58 (80.6%), 6 (8.3%), and 18 (25.0%) patients had experienced local, regional, and distant failure, respectively. Few severe toxicities were observed. The conservative definitive RT with modern technique was effective for very elderly EC patients in short term with low rate and tolerable toxicities. Local residue or recurrence was the most common failure pattern. The aging‐related prognostic factors concerned nutrition and immune, such as NRI and NLR before RT, should be considered for use in future clinical practice.

• Concurrent chemoradiation
• definitive radiotherapy
• neutrophil-lymphocyte ratio
• nutritional risk index
• very elderly esophageal cancer