TY - JOUR
T1 - Adjuvant radiotherapy on older and oldest elderly rectal cancer patients
AU - Fiorica, F.
AU - Cartei, F.
AU - Carau, B.
AU - Berretta, S.
AU - Spartà, D.
AU - Tirelli, U.
AU - Santangelo, A.
AU - Maugeri, D.
AU - Luca, S.
AU - Leotta, C.
AU - Sorace, R.
AU - Berretta, M.
PY - 2009/7
Y1 - 2009/7
N2 - The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged ≥75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged ≥75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years (range 75-90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and 14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients but one completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-year overall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with no or mild co-morbidities (p = 0.002) and a good performance status (p = 0.003). The cancer-free survival at 2 and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was found between patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.
AB - The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity in the patients aged ≥75 with advanced rectal cancer. From January 2002 to December 2006, 41 consecutive patients (27 men and 14 women) aged ≥75 received radiotherapy for local advanced rectal cancer, 9 in a pre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy. Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluation index (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years (range 75-90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and 14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients but one completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-year overall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with no or mild co-morbidities (p = 0.002) and a good performance status (p = 0.003). The cancer-free survival at 2 and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was found between patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is good and rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have a significantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining life expectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirm these results.
KW - Co-morbidities with rectal cancer
KW - Elderly patients
KW - Radiotherapy of rectal cancer
KW - Rectal cancer
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U2 - 10.1016/j.archger.2008.05.001
DO - 10.1016/j.archger.2008.05.001
M3 - Article
C2 - 18573548
AN - SCOPUS:67349130160
VL - 49
SP - 54
EP - 59
JO - Archives of Gerontology and Geriatrics
JF - Archives of Gerontology and Geriatrics
SN - 0167-4943
IS - 1
ER -