title: Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older.
abstract: OBJECTIVE
  To assess the safety and outcomes of radiotherapy (RT) or chemoradiotherapy (CRT) in elderly patients (≥70) with rectal cancer.
  
  
  METHODS
  Elderly patients aged 70 and older with rectal cancer, who were treated with RT or CRT at a single institution, were retrospectively analyzed. Performance status (KPS and ECOG score) and comorbidity (Charlson comorbidity index) were calculated, and their correlation with treatment toxicity and overall survival were studied. Risk factors for overall survival were investigated using univariate and multivariate survival analysis.
  
  
  RESULTS
  A total of 126 patients with locally advanced disease, local recurrence or synchronous metastasis were included, with a 3-year OS rate of 48.1%. Scheduled dosage of radiation was delivered to 69% of patients. Grade 3 toxicities occurred more often in patients treated with CRT versus RT. The occurrence of grade 3 toxicities was not related to KPS score, ECOG score, number of comorbidities, and Charlson score. Multivariate analysis found that only age and Charlson score were independent prognostic factors for predicting patients' 3-year OS. The 3-year OS rate was significantly higher in patients with Charlson score <4 vs Charlson score ≥4 (71.1% vs. 26.4%, P=0.0003).
  
  
  CONCLUSIONS
  Although toxicities may be significant, elderly patients with rectal cancer of varied stages can be safely treated with RT or CRT with careful monitoring and frequent modification of treatment. Except for patients' age, Charlson comorbidity index may be helpful in assessing patients' outcomes in elderly patients with rectal cancer.
authors.affiliation: Department of Radiological Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai 200032, People's Republic of China.
authors.forename: Xin
authors.initials: X
authors.lastname: Cai
authors.forename: Hongbin
authors.initials: H
authors.lastname: Wu
authors.forename: Junjie
authors.initials: J
authors.lastname: Peng
authors.forename: Ji
authors.initials: J
authors.lastname: Zhu
authors.forename: Sanjun
authors.initials: S
authors.lastname: Cai
authors.forename: Gang
authors.initials: G
authors.lastname: Cai
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome