title: Systemic treatment of gastrointestinal cancer in elderly patients.
abstract: OBJECTIVE
  Gastrointestinal cancer (GI) incidence increases with each decade of life and is the leading cause of death in patients aged >70 years. Nevertheless, elderly patients are often excluded or underrepresented in clinical trials. We performed a review of current recommendations in the management of GI elderly cancer patients.
  
  
  METHODS
  A comprehensive literature review was performed analyzing data about several meta-analysis and studies regarding chemotherapeutic regimens in elderly patients with colorectal and gastroesophageal cancers.
  
  
  RESULTS
  Most of the studies demonstrated that the elderly experience the same advantages and toxicities from chemotherapy as younger individuals despite the fact that the data reviewed in this article provide evidence that elderly with GI cancers are underrepresented in clinical trials and few trials are conducted addressing the different risks and aims in older population. Each individual should be assessed for an appropriate regimen of treatment in the adjuvant or metastatic gastrointestinal cancer setting, and the decision of how to treat elderly must incorporate goals and preferences of the patient after a careful discussion of risks and benefits.
  
  
  CONCLUSIONS
  Chronological age alone is not a sufficient factor to withhold curative/palliative treatment from an elderly GI cancer patient, and cofactors regarding their functional, social, and mental status have to be considered. For this purpose, several tools exist that may be utilized, such as geriatric assessment scores, comorbidity indices, frailty indices, scores for predicting toxicity from chemotherapy, and prognostic indices for survival.
authors.affiliation: Geriatric Oncology Unit-Medical Oncology Department, Vito Fazzi Hospital, Lecce, Italy. silvileo@libero.it
authors.forename: Silvana
authors.initials: S
authors.lastname: Leo
authors.forename: Caterina
authors.initials: C
authors.lastname: Accettura
authors.forename: Antonio
authors.initials: A
authors.lastname: Gnoni
authors.forename: Antonella
authors.initials: A
authors.lastname: Licchetta
authors.forename: Marianna
authors.initials: M
authors.lastname: Giampaglia
authors.forename: Annamaria
authors.initials: A
authors.lastname: Mauro
authors.forename: Valeria
authors.initials: V
authors.lastname: Saracino
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
mesh_terms: D000368:Aged; D005770:Gastrointestinal Neoplasms / Q000628:therapy*; D015577:Geriatric Assessment; D006801:Humans; D010166:Palliative Care