Frailty profile precluding CROSS / FLOT / definitive CRT in esophageal: ECOG ≥3, OR (age...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-ESOPH-FRAILTY-AGE`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-ESOPHAGEAL`
Sources	`SRC-ESMO-ESOPHAGEAL-2024` `SRC-NCCN-ESOPHAGEAL-2025`

Red Flag Origin

Definition	Frailty profile precluding CROSS / FLOT / definitive CRT in esophageal: ECOG ≥3, OR (age ≥75 + Charlson ≥3), OR composite (age ≥70 + albumin <3.0 + ≥10% weight loss + sarcopenia). Triggers definitive RT-only (palliative-intent), best-supportive-care with palliative stenting + nutrition optimization.
Clinical direction	de-escalate
Category	frailty-age

Trigger Logic

{
  "any_of": [
    {
      "comparator": ">=",
      "finding": "ecog",
      "threshold": 3
    },
    {
      "all_of": [
        {
          "comparator": ">=",
          "finding": "age",
          "threshold": 75
        },
        {
          "comparator": ">=",
          "finding": "charlson_score",
          "threshold": 3
        }
      ]
    }
  ],
  "type": "composite_score"
}

Notes

Esophageal cancer disproportionately affects older patients; pre-CROSS nutrition optimization (PEG/J-tube) often required. Frail elderly: hypofractionated RT 30-40 Gy palliative + stenting for dysphagia control.

Used By

Indications

IND-ESOPH-METASTATIC-2L-HER2-POSITIVE-T-DXD - IND-ESOPH-METASTATIC-2L-HER2-POSITIVE-T-DXD
IND-ESOPH-METASTATIC-2L-NIVO-SQUAMOUS - IND-ESOPH-METASTATIC-2L-NIVO-SQUAMOUS
IND-ESOPH-METASTATIC-2L-PEMBRO-CPS10 - IND-ESOPH-METASTATIC-2L-PEMBRO-CPS10