Abstract
The thought of subjecting an elderly patient with rectal cancer to protocol-based neoadjuvant chemoradiation (NACTRT), surgery and adjuvant chemotherapy is sought with fear due to their multiple comorbidities and impaired functional status associated with the process of ageing. Hence, many a times the treatment is compromised and it is a fact that this subgroup of patients is underrepresented in most of the clinical trials. This study was aimed at analysing the perioperative and oncologic outcomes after protocol-based treatment of rectal cancer in the elderly patients, defined here as those with age ≥70 years. Prospective analysis of medical records of rectal cancer patients was done who were ≥70 years of age and were diagnosed and treated at Regional Cancer Centre (RCC), Thiruvanathapuram from 2008 to 2012. In this 5-year period, a total of 339 rectal cancer patients underwent surgery as part of multimodality treatment with curative intent. Of them, 75 patients were ≥70 years of age. Half of them had one or more comorbidities (54%) and majority were locally advanced at presentation (77%). Forty-seven (62%) cases received NACTRT and all of them tolerated RT dose (50.4 Gy) without modification. Anterior resection (AR) was performed in 48 (64%) and abdominoperineal resection (APR) in remaining. Diverting stoma was made in four; of which three remained permanent. Two colostomies were performed for delayed leaks. Three patients (4%) died within 30 days due to leak, sepsis and cardiopulmonary causes. Two thirds (49/75) received adjuvant chemotherapy (ACT) but only 55% of them (27/49) could complete all the cycles without dose modification. The median survival was 28 months. The 3-year disease-free survival (DFS) and overall (OS) were 80.1 and 83.9%, respectively. There were 11 distant recurrences including two locoregional recurrences. The morbidity and mortality of multimodality therapy is reasonable to proceed with radical treatment with curative intent in the elderly patients with rectal cancer.
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References
GLOBOCAN 2012. Cancer Fact Sheets. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx
Population based Cancer Registry Report 2012, Regional Cancer Centre, Thiruvanathapuram, India
Manceau G, Karoui M, Mortensen NJ, Hannoun L (2012) Comparative outcomes of rectal cancer surgery between elderly and non elderly patients: a systematic review. Lancet Oncol 13:e526–e536
Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen- Heijnen ML (2006) Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer 42:3015–3021
Lin JK, Yueh TC, Chang SC et al (2011) The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg 15:2251–2261
Chautard J, Alves A, Zalinski S, Bretagnol F, Valleur P, Panis Y (2008) Laparoscopic colorectal surgery in elderly patients: a matched case-control study in 178 patients. J Am Coll Surg 206:255–260
Lombardi R, Cuicchi D, Pinto C, Di Fabio F, Iacopino B, Cola B (2009) Neoadjuvant chemoradiation for rectal cancer in patients aged 75 years or older. From XXI Annual Meeting of The Italian Society of Geriatric Surgery Terni, Italy. 4–6 December 2008. BMC Geriatr 9(Suppl 1):A2
Cagney DN, Cagney C, Gillham C (2011) Tolerance of neoadjuvant chemoradiation for rectal cancer in patients age 70 or older. 2011 ASCO Annual Meeting. J Clin Oncol 29(suppl):abstr e19565
Law WL, Choi HK, Ho JW, Lee YM, Seto CL (2006) Outcomes of surgery for mid and distal rectal cancer in the elderly. World J Surg 30:598–604
Kessler H, Hermanek P Jr, Wiebelt H (1993) Operative mortality in carcinoma of the rectum. Results of the German multicentre study. Int J Color Dis 8:158–166
Den Dulk M, Smit M, Peeters KC et al (2007) A multivariate analysis of limiting factors for stoma reversal in patients with rectal cancer entered into the total mesorectal excision (TME) trial: a retrospective study. Lancet Oncol 8:297–303
David GG, Slavin JP, Willmott S, Corless DJ, Khan AU, Selvasekar CR (2010) Loop ileostomy following anterior resection: is it really temporary? Color Dis 12:428–432
Khrizman P, Niland JC, ter Veer A, Milne D et al (2012) Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: a National Comprehensive Cancer Network Analysis. J Clin Oncol 31:30–38
Jung B, Pahlman L, Johansson R, Nilsson E (2009) Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish Rectal Cancer Registry 1995–2004. BMC Cancer 9:68
Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M (2007) Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg 246:215–221
Mollen RM, Damhuis RA, Coebergh JW (1997) Local recurrence and survival in patients with rectal cancer, diagnosed 1981–86: a community hospital-based study in the south-east Netherlands. Eur J Surg Oncol 23:20–23
Damhuis RA, Wiggers T, Wereldsma JC (1997) Association between age and local recurrence of rectal cancer: results from a retrospective study of 902 patients. Int J Color Dis 12:235–239
Miguel I, Luis A, Fonseca R et al (2015) Rectal cancer management in elderly patients: experience of a single Portuguese institution. The Journal Of Community And Supportive Oncology 13:8–13
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Muralee, M., Singh, R., Mathew, A.P. et al. Radical Treatment of Rectal Cancer in Elderly Is Feasible than Feared: Results from a Tertiary Care Centre. Indian J Surg Oncol 8, 479–483 (2017). https://doi.org/10.1007/s13193-017-0659-9
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DOI: https://doi.org/10.1007/s13193-017-0659-9