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Determining Therapeutic Approaches in the Elderly with Rectal Cancer

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Abstract

Background

To evaluate the toxicity and feasibility of pelvic radiotherapy (RT) and/or surgery in elderly patients with locally advanced low-lying rectal cancer.

Patients and methods

From November 1999 to November 2005, 51 patients aged ≥70 years who underwent RT for locally advanced low-lying rectal cancer were retrospectively examined. Variables considered were age, co-morbidities (evaluated according to the Charlson score and the Cumulative Illness Rating Scale-Geriatric [CIRS-G] score) and surgery versus no surgery.

Results

The median age was 80 years (range 70–94 years) and the male: female ratio was 33: 18. A total of 5.9% of patients were considered ‘fit’, 72.5% had one or more CIRS-G grade 1 or 2 co-morbidities and 21.6% had one or more CIRS-G grade 3 co-morbidities. 54.9% of patients underwent surgery and 45.1% underwent RT. Only 9 of 21 (42.8%) patients who underwent radical resection received the full course of adjuvant RT and only seven (50%) of all patients treated with RT alone received the full dose of therapy. Patients with one or more CIRS-G grade 3 co-morbidities reported similar numbers of grade 1–2 toxicities as patients with one or more CIRS-G grade 2 co-morbidities.

Conclusion

Notwithstanding the small number of patients analysed, the findings of this study indicate that elderly patients with rectal cancer and mild comorbidities could probably receive the same treatment as fit elderly patients, given that tolerability appeared to be similar in both categories of patients. Neither age nor co-morbidities should be considered reasons to deny the patient the possible benefits of receiving complete treatment. Moreover, Multidimensional Geriatric Assessment should always be undertaken to help clinicians make better decisions about treatment. Further prospective trials are needed to confirm these results.

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References

  1. Landis SH, Murray T, Bolden S, et al. Cancer statistics 1999. Cancer J Clin 1999; 49: 8–31

    Article  CAS  Google Scholar 

  2. Walter LC, Corvinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001; 285: 2750–6

    Article  PubMed  CAS  Google Scholar 

  3. Jessup JM, McGinnis LS, Steele GD, et al. The National Cancer Data Base: report on colon cancer. Cancer 1996; 78: 918–26

    Article  PubMed  CAS  Google Scholar 

  4. Kohne H, Grothey A, Bekemeyer C, et al. Chemotherapy in elderly patients with colorectal cancer. Ann Oncol 2001; 12: 435–42

    Article  PubMed  CAS  Google Scholar 

  5. Grobovsky L, Kaplon M, Krozser-Hamati A, et al. Features of cancer in frail elderly patients (pts) (85 years of age) [abstract no. 2469]. Proc Am Soc Clin Oncol 2000; 18: 139

    Google Scholar 

  6. Rodel C, Grabenbauer GG, Shick C, et al. Preoperative radiation with concurrent 5-fluorouracil for locally-advanced T4 primary rectal cancer. Strahlenther Onkol 2000; 176: 161–7

    Article  PubMed  CAS  Google Scholar 

  7. Videtic GM, Fisher BJ, Perera FE, et al. Preoperative radiation with concurrent 5-fluorouracil continuous infusion for locally advanced unresectable rectal cancer. Int J Radiat Oncol Biol Phys 1998; 42(2): 319–24

    Article  PubMed  CAS  Google Scholar 

  8. Chan AK, Wong AO, Langevin J, et al. Preoperative CT and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys 2000; 48(3): 843–56

    Article  PubMed  CAS  Google Scholar 

  9. Grann A, Feng C, Wong D, et al. Preoperative combined modality therapy for clinically resectable uT3 rectal adenocarcinoma. Int J Radiat Oncol Biol Phys 2001; 49: 987–95

    Article  PubMed  CAS  Google Scholar 

  10. Valentini V, Coco C, Cellinin N, et al. Ten years of preoperative chemoradiation for extraperitoneal T3 rectal cancer: acute toxicity, tumor response, sphincter preservation in three consecutive studies. Int J Radiat Oncol Biol Phys 2001; 51: 371–83

    Article  PubMed  CAS  Google Scholar 

  11. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in gero-psychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 1992; 41: 237–48

    Article  PubMed  CAS  Google Scholar 

  12. Extermann M, Overcash J, Lyman GH, et al. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998; 16(4): 1582–7

    PubMed  CAS  Google Scholar 

  13. Firat S, Pleister A, Byhardt RW, et al. Age is independent of comorbidity influencing patient selection for combined modality therapy for treatment of stage III nonsmall cell lung cancer (NSCLC). Am J Clin Oncol 2006; 29(3): 252–7

    Article  PubMed  CAS  Google Scholar 

  14. Firat S, Byhardt RW, Gore E. Comorbidity and Karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four RTOG studies. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2002; 54(2): 357–64

    Article  PubMed  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40(5): 373–83

    Article  PubMed  CAS  Google Scholar 

  16. Ekberg L, Holmberg O, Wittgren L, et al. What margins should be added to the clinical target volume in radiotherapy treatment planning for lung cancer? Radiother Oncol 1998 Jul; 48(1): 71–7

    Article  PubMed  CAS  Google Scholar 

  17. Withers HR, Taylor JM, Maciejewski B. Treatment volume and tissue tolerance. Int J Radiat Oncol Biol Phys 1988 Apr; 14(4): 751–9

    Article  PubMed  CAS  Google Scholar 

  18. Enker EW, Thaler TH, Cranon LM, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995; 181: 335–46

    PubMed  CAS  Google Scholar 

  19. AJCC American Joint Committee on Cancer. In: Fleming DI, Cooper SJ, Henson ED, et al., editors. AJCC cancer staging manual. 5th ed. Philadelphia (PA): Lippincott-Raven, 1997: 83–90

  20. Kaplan EL, Meier P. Non parametric estimation for incomplete observation. J Am Stat Assoc 1958; 53: 457–81

    Article  Google Scholar 

  21. Common terminology criteria for adverse events: version 3.0 (CTCAE), 2003 March 31. Publish date: August 9, 2006 [online]. Available from URL: http://ctep.cancer.gov/forms/CTCAEv3.pdf [Accessed 2007 Aug 14]

  22. Popescu RA, Norman A, Ross PJ, et al. Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol 1999; 17(8): 2412–8

    PubMed  CAS  Google Scholar 

  23. Chiara S, Nobile MT, Vincenti M, et al. Advanced colorectal cancer in the elderly: results of consecutive trials with 5-fluorouracil-based chemotherapy. Cancer Chemother Pharmacol 1998; 42(4): 336–40

    Article  PubMed  CAS  Google Scholar 

  24. Stein BN, Petrelli NJ, Douglass HO, et al. Age and sex are independent predictors of 5-FU toxicity: analysis of a large scale phase III trial. Cancer 1995; 75: 11–7

    Article  PubMed  CAS  Google Scholar 

  25. Gomez H, Mas L, Casanova L, et al. Elderly patients with aggressive non-Hodgkin’s lymphoma treated with CHOP chemotherapy plus granulocyte-macrophage colony-stimulating factor: identification of two age subgroups with differing haematologic toxicity. J Clin Oncol 1998; 16: 2352–8

    PubMed  CAS  Google Scholar 

  26. Lyman GH, Kuderer NM, Balducci L. Cost-benefit analysis of granulocyte colony-stimulating factor in the management of elderly cancer patients. Curr Opin Hematol 2002; 9: 207–14

    Article  PubMed  Google Scholar 

  27. Repetto L, Biganzoli L, Koehne CH, et al. EORTC Cancer in the Elderly Task Force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer 2003; 39(16): 2264–72

    Article  PubMed  CAS  Google Scholar 

  28. Crawford J, Dale DC, Lyman GH. Chemotherapy-induced neutropenia: risks, consequences, and new directions for its management. Cancer 2004; 100(2): 228–37

    Article  PubMed  Google Scholar 

  29. Lyman GH, Kuderer N, Agboola O, et al. Evidence-based use of colony-stimulating factors in elderly cancer patients. Cancer Control 2003; 10(6): 487–99

    PubMed  Google Scholar 

  30. Balducci L, Beghe C. The application of the principles of geriatrics to the management of the older person with cancer. Crit Rev Oncol Hematol 2000; 35(3): 147–54

    Article  PubMed  CAS  Google Scholar 

  31. Chiappa A, Zbar AP, Bertani E, et al. Surgical outcomes for colorectal cancer patients including the elderly. Hepatogastroenterology 2001; 48(38): 440–4

    PubMed  CAS  Google Scholar 

  32. Audisio RA, Bozzetti F, Gennari R, et al. The surgical management of elderly cancer patients; recommendations of the SIOG surgical task force. Eur J Cancer 2004; 40(7): 926–38

    Article  PubMed  CAS  Google Scholar 

  33. Ramesh HS, Jain S, Audisio RA. Implications of aging in surgical oncology. Cancer J 2005; 11(6): 488–94

    Article  PubMed  Google Scholar 

  34. Kiran RP, Pokala N, Dudrick SJ. Long-term outcome after operative intervention for rectal cancer in patients aged over 80 years: analysis of 9,501 patients. Dis Colon Rectum 2007; 50(5): 604–10

    Article  PubMed  Google Scholar 

  35. Shahir MA, Lemmens VE, van de Poll-Franse LV, et al. 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(17): 3015–21

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

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Correspondence to Lara Maria Pasetto.

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Pasetto, L.M., Basso, U., Friso, M.L. et al. Determining Therapeutic Approaches in the Elderly with Rectal Cancer. Drugs Aging 24, 781–790 (2007). https://doi.org/10.2165/00002512-200724090-00006

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