title: Rectal cancer management in elderly patients: experience of a single Portuguese institution.
abstract: BACKGROUND
  The incidence of rectal cancer increases with age, and older patients are more likely to have other chronic conditions that can affect outcome and tolerability of treatment.
  
  
  OBJECTIVE
  The incidence of rectal cancer increases with age, and older patients are more likely to have other chronic conditions that can affect outcome and tolerability of treatment.
  
  
  METHODS
  59 patients aged 75 years and older with stage II-III rectal cancer who were treated during a 3-year period were included in the study. Comorbidities were assessed using the Charlson Comorbidity Index (CCI) and the patients were divided into 2 groups based on their CCI scores: Fit (score of 0-1 points) and Vulnerable (score of greater than or = 2). Primary endpoint was survival at 1 and 3 years.
  
  
  RESULTS
  The sample included 43 patients (72.9%) in the Fit group and 16 patients (27.1%) in the Vulnerable group. The most common comorbidities were myocardial infarction, diabetes, and chronic lung disease. One-year survival the same between the groups (P = .330), but 3-year survival was lower in the Vulnerable group patients (83.7% vs 56.3%, respectively; P = .040). The rates of neoadjuvant chemo- and radiotherapy use and low anterior resection performance were the same between the groups. Colostomy closure was achieved more frequently in the Fit group compared with the Vulnerable group (83.3% vs 55.6%; P = .083). There was no difference in mean disease-free survival, grade 3-4 toxicity, and dose reduction between the groups.
  
  
  CONCLUSIONS
  Comorbidity assessment should always be included in standard oncological management of elderly patients. Fit patients can be managed with standard treatment and may bene¦t from a conventional, more aggressive approach in their therapy.
authors.affiliation: Department of Medical Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal. imiguel@ipolisboa.min-saude.pt.
authors.forename: Isalia
authors.initials: I
authors.lastname: Miguel
authors.affiliation: Department of Medical Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Luis
authors.affiliation: Department of Pathology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fonseca
authors.affiliation: Department of Surgery, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: d'Orey
authors.affiliation: Department of Surgery, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Limbert
authors.affiliation: Department of Gastroenterology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Isadora
authors.initials: I
authors.lastname: Rosa
authors.affiliation: Department of Gastroenterology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Joao P
authors.initials: JP
authors.lastname: Silva
authors.affiliation: Department of Radiology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Venancio
authors.affiliation: Department of Radiotherapy, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Department of Radiotherapy, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Luisa
authors.initials: L
authors.lastname: Mirones
authors.affiliation: Department of Radiotherapy, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Goncalo
authors.initials: G
authors.lastname: Fernandez
authors.affiliation: Department of Medical Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, EPE, Lisbon, Portugal.
authors.forename: Joao
authors.initials: J
authors.lastname: Freire
keywords: comorbidity; elderly; rectal cancer