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


METHODS
From November 1999 to November 2005, 51 patients aged >or=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.


CONCLUSIONS
Notwithstanding the small number of patients analysed, the findings of this study indicate that elderly patients with rectal cancer and mild co-morbidities 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.
Pasetto
Lara Maria
LM
Medical Oncology 2nd, Istituto Oncologico Veneto, Padova, Italy. laramary@libero.it
Basso
Umberto
U
Friso
Maria Luisa
ML
Pucciarelli
Salvatore
S
Agostini
Marco
M
Rugge
Massimo
M
Sinigaglia
Giulietta
G
Lise
Mario
M
Sotti
Guido
G
Monfardini
Silvio
S
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D010349:Patient Compliance; D018579:Patient Selection; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome