Feasibility of neoadjuvant therapy for elderly patients with locally advanced rectal cancer

  • Tetsuro Tominaga
  • Toshiya NagasakiEmail author
  • Takashi Akiyoshi
  • Yosuke Fukunaga
  • Yoshiya Fujimoto
  • Tomohiro Yamaguchi
  • Tsuyoshi Konishi
  • Satoshi Nagayama
  • Masashi Ueno
Original Article



The feasibility of neoadjuvant therapy (NAT) for elderly patients with rectal cancer has not been evaluated well.


Between 2004 and 2014, 506 patients with locally advanced low rectal cancer underwent curative resection. Fifty-four were over 75 years old (elderly group), and 452 were under 75 years old (young group). The patients were divided into sub-groups according to whether they received NAT.


Nineteen (35.2%) patients from the elderly group and 348 (77.0%) from the young group received NAT. The proportion of patients who received NAT was significantly lower in the elderly group. In the elderly group, the median age and prevalence of co-morbidities were significantly lower in patients with than in those without NAT. The incidence of severe adverse events was similar in the two groups. On multivariate analysis, age was not related to postoperative complications in patients who received NAT. The 5-year local recurrence rate was significantly lower in the elderly patients who received NAT, and similar to that of the young patients who received NAT.


Neoadjuvant therapy was feasible and should be considered as a treatment option for carefully selected elderly patients with locally advanced low rectal cancer.


Rectal cancer Elderly patients Chemoradiotherapy Neoadjuvant therapy 


Author contributions

TT and TN designed most of the study. TT analyzed the data. All coauthors contributed substantially to this study and fulfilled the requirements for authorship as per the guidelines of the International Committee of Medical Journal Editors. All authors have read and approved the final versions of the manuscript.

Compliance with ethical standards

Conflict of interest

We have no conflicts of interest to declare.

Informed consent

Additional informed consent was obtained from all participants whose identifying information is included in this article.


  1. 1.
    Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.CrossRefGoogle Scholar
  2. 2.
    Breugom AJ, Van Gijn W, Muller EW, Berglund A, van den Broek CBM, Fokstuen T, et al. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015;26:696–701.CrossRefGoogle Scholar
  3. 3.
    Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.CrossRefGoogle Scholar
  4. 4.
    Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2016;23:1–34.CrossRefGoogle Scholar
  5. 5.
    Kotake K, Asano M, Ozawa H, Kobayashi H, Sugihara K. Tumour characteristics, treatment patterns and survival of patients aged 80 years or older with colorectal cancer. Colorectal Dis. 2015;17:205–15.CrossRefGoogle Scholar
  6. 6.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.CrossRefGoogle Scholar
  7. 7.
    Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group. Cancer incidence and incidence rates in Japan in a study of 25 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2008;2014(44):388–96.Google Scholar
  8. 8.
    Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.CrossRefGoogle Scholar
  9. 9.
    Bohac GC, Guaqueta D, Cheng DM, Aschengrau A, Hartshorn KL. Disparity in the use of combined modality therapy for rectal cancer in the older adult. J Geriatr Oncol. 2013;4:90–7.CrossRefGoogle Scholar
  10. 10.
    Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.CrossRefGoogle Scholar
  11. 11.
    Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Pudelko M, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004;72:15–24.CrossRefGoogle Scholar
  12. 12.
    Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Prognostic impact of neutrophil-to-lymphocyte ratio in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy. Dig Surg. 2015;32:496–503.CrossRefGoogle Scholar
  13. 13.
    Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Preoperative chemoradiotherapy might improve the prognosis of patients with locally advanced low rectal cancer and lateral pelvic lymph node metastases. World J Surg. 2017;41:876–83.CrossRefGoogle Scholar
  14. 14.
    Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 2014;21:189–96.CrossRefGoogle Scholar
  15. 15.
    Cancer Therapy Evaluation Program (2017) Common terminology criteria for adverse events (CTCAE) v5.0. National Cancer Institute.
  16. 16.
    Balducci L. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.CrossRefGoogle Scholar
  17. 17.
    Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, et al. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol. 2015;26:463–76.CrossRefGoogle Scholar
  18. 18.
    Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118:3377–86.CrossRefGoogle Scholar
  19. 19.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefGoogle Scholar
  20. 20.
    Cai X, Wu H, Peng J, Zhu J, Cai S, Cai G, et al. Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older. Radiat Oncol. 2013;8:86.CrossRefGoogle Scholar
  21. 21.
    Tougeron D, Roullet B, Paillot B, Hamidou H, Tourani J, Bensadoun R, et al. Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer : results from two French tertiary centres. Dig Liver Dis. 2012;44:350–4.CrossRefGoogle Scholar
  22. 22.
    Suhool A, Moszkowicz D, Cudennec T, Vychnevskaia K, Malafosse R, Beauchet A, et al. Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg. 2018;155:17–25.CrossRefGoogle Scholar
  23. 23.
    Ausili Cèfaro G, Genovesi D, Vinciguerra A, Augurio A, Di Tommaso M, Marchese R, et al. Effects of preoperative radiochemotherapy with capecitabine for resectable locally advanced rectal cancer in elderly patients. Tumori. 2012;98:622–9.CrossRefGoogle Scholar
  24. 24.
    François E, Azria D, Gourgou-Bourgade S, Jarlier M, Martel-Laffay I, Hennequin C, et al. Results in the elderly with locally advanced rectal cancer from the ACCOR12/PRODIGE 2 phase III trial: tolerance and efficacy. Radiother Oncol. 2014;110:144–9.CrossRefGoogle Scholar
  25. 25.
    Choi Y, Kim JH, Kim J-W, Kim JW, Lee K-W, Oh H-K, et al. Preoperative chemoradiotherapy for elderly patients with locally advanced rectal cancer-a real-world outcome study. Jpn J Clin Oncol. 2016;46:1108–17.CrossRefGoogle Scholar
  26. 26.
    Jiang DM, Raissouni S, Mercer J, Kumar A, Goodwin R, Heng DY, et al. Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer. Ann Oncol. 2015;26:2102–6.CrossRefGoogle Scholar
  27. 27.
    Pasetto LM, Friso ML, Pucciarelli S, Basso U, Falci C, Bortolami A, et al. Rectal cancer neoadjuvant treatment in elderly patients. Anticancer Res. 2006;26:3913–23.Google Scholar
  28. 28.
    Jung B, Påhlman L, Johansson R, Nilsson E. Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004. BMC Cancer. 2009;9:1–8.CrossRefGoogle Scholar
  29. 29.
    Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen-Heijnen ML. 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. 2006;42:3015–21.CrossRefGoogle Scholar
  30. 30.
    Perez DL, Caceres AN, Toscano NA, Casal NJ. Results of colon cancer surgery in patients over 75 years old. ANZ J Surg. 2018;88:11–5.CrossRefGoogle Scholar
  31. 31.
    Abbott RD, Donahue RP, Kannel WB, Wilson PW. The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study. JAMA. 1988;260:3456–60.CrossRefGoogle Scholar
  32. 32.
    Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Tetsuro Tominaga
    • 1
  • Toshiya Nagasaki
    • 1
    Email author
  • Takashi Akiyoshi
    • 1
  • Yosuke Fukunaga
    • 1
  • Yoshiya Fujimoto
    • 1
  • Tomohiro Yamaguchi
    • 1
  • Tsuyoshi Konishi
    • 1
  • Satoshi Nagayama
    • 1
  • Masashi Ueno
    • 1
  1. 1.Department of Gastroenterological Surgery, Cancer Institute Hospital, Gastroenterological CenterJapanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations