Preoperative radiotherapy in elderly patients with rectal cancer.
OBJECTIVE
We performed a retrospective analysis in order to evaluate the compliance with preoperative radiotherapy in patients aged>or=70 with locally advanced resectable rectal cancer, and to evaluate the influence of comorbidities on treatment tolerance and oncological results.


METHODS
From March 1984 to December 2000, 95 patients with T3-T4 N0 M0 rectal cancer received a preoperative radiotherapy in 2 radiotherapy departments. Nineteen patients received concomitant chemotherapy.


RESULTS
All patients completed the radiation schedule. Six patients suffered grade 3 acute WHO toxicity. Surgical resection was performed in 87 patients. There were 3 post-operative deaths. Analysis of peri-operative complications showed thromboembolism (4.9%), ileus (9.8%) and diarrhoea (6.1%). After a median follow-up of 29 months, the 3- and 5-year overall survival rates were 65% and 49% respectively. In univariate analysis, a tumour located in the mid part of the rectum, a radiation dose less than 40 Gy, the absence of chemotherapy were significantly associated with a poor prognosis. There was a trend to a better survival for patients with a Charlson score of 0 (P=0.0584). In multivariate analysis, only initial WHO performance status was significant.


CONCLUSIONS
Compliance with preoperative radiotherapy is good in elderly patients. Toxicity rates are similar to those described in randomised trials in which only younger patients were included. Initial WHO performance status<or=1 is significantly associated with better survival.
Lorchel
Fabrice
F
Service d'Oncologie-Radiothérapie, CHU Jean Minjoz, 25030 Besançon Cedex, France. lorchel.fabrice@wanadoo.fr
Peignaux
Karine
K
Créhange
Gilles
G
Bosset
Mathieu
M
Puyraveau
Marc
M
Mercier
Mariette
M
Bosset
Jean-François
JF
Maingon
Philippe
P
D018806:APACHE; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003627:Data Interpretation, Statistical; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D017567:Karnofsky Performance Status; D002955:Leucovorin / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012007:Rectum / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014803:Vitamin B Complex / Q000008:administration & dosage / Q000627:therapeutic use; D014944:World Health Organization
D000964:Antimetabolites, Antineoplastic; D014803:Vitamin B Complex; D002955:Leucovorin; D005472:Fluorouracil