title: Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer.
abstract: BACKGROUND
  Studies of clinical outcomes of elderly patients treated with neoadjuvant chemoradiation (nCRT) for locally advanced rectal cancer (LARC) are limited. Our aim was to assess the impact of age on clinical outcomes in a large multi-institutional database.
  
  
  METHODS
  Data for patients diagnosed with LARC who received nCRT and curative-intent surgery between 2005 and 2012 were collected from five major Canadian cancer centers. Age was analyzed as a continuous and dichotomous variable (< 70 versus ≥ 70 years) and correlated with disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Cox regression models were used to adjust for important prognostic factors.
  
  
  RESULTS
  Of 1172 patients included, 295 (25%) were ≥ 70 years, and they were less likely to receive adjuvant chemotherapy (ACT; 60% versus 79%, P < 0.0001), oxaliplatin-based ACT (12% versus 31%, P < 0.0001), less likely to complete nCT (76% versus 86%, P < 0.001), and more likely to be anemic at initiation of nCRT (42% versus 30%, P = 0.0004). In multivariate analyses, age ≥ 70 years was associated with similar DFS [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.68-1.26, P = 0.63], similar CSS (HR 0.81, 95% CI 0.46-1.41, P = 0.45), and similar OS (HR 1.28, 95% CI 0.88-1.86, P = 0.20), compared with the younger age group. As a continuous variable, increasing age was not predictive of DFS (HR 1.00, 95% CI 0.99-1.02, P = 0.49) or CSS (HR 1.002, 95% CI 0.98-1.02, P = 0.88); however, it correlated with an inferior OS (HR 1.02, 95% CI 1.00-1.03, P = 0.04).
  
  
  CONCLUSIONS
  Elderly patients (≥ 70 years) who receive nCRT followed by surgery appear to have similar outcomes compared with younger patients. Decisions regarding eligibility for nCRT and surgery should not be based on age alone.
authors.affiliation: Faculty of Medicine, University of Ottawa, Ottawa.
authors.forename: D M
authors.initials: DM
authors.lastname: Jiang
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: S
authors.initials: S
authors.lastname: Raissouni
authors.affiliation: Department of Oncology, Dr. H. Bliss Murphy Cancer Centre, St. John's.
authors.forename: J
authors.initials: J
authors.lastname: Mercer
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital, Ottawa.
authors.forename: R
authors.initials: R
authors.lastname: Goodwin
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: D Y
authors.initials: DY
authors.lastname: Heng
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: P A
authors.initials: PA
authors.lastname: Tang
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: C
authors.initials: C
authors.lastname: Doll
authors.affiliation: Department of Surgery, University of Calgary, Calgary.
authors.forename: A
authors.initials: A
authors.lastname: MacLean
authors.affiliation: Department of Oncology, Dr. H. Bliss Murphy Cancer Centre, St. John's.
authors.forename: E
authors.initials: E
authors.lastname: Powell
authors.affiliation: Department of Oncology, Cross Cancer Institute, Edmonton.
authors.forename: J
authors.initials: J
authors.lastname: Price-Hiller
authors.affiliation: Department of Oncology, Tom Baker Cancer Centre, Calgary.
authors.forename: J
authors.initials: J
authors.lastname: Monzon
authors.affiliation: Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
authors.forename: W Y
authors.initials: WY
authors.lastname: Cheung
authors.affiliation: Division of Medical Oncology, The Ottawa Hospital, Ottawa mvickers@toh.on.ca.
authors.forename: M M
authors.initials: MM
authors.lastname: Vickers
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069287:Capecitabine / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000401:mortality*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D011379:Prognosis; D011799:Quinazolines / Q000008:administration & dosage; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D013876:Thiophenes / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D009944:Organoplatinum Compounds; D011799:Quinazolines; D013876:Thiophenes; D000077150:Oxaliplatin; D000069287:Capecitabine; C068874:raltitrexed; D005472:Fluorouracil
keywords: elderly patients; neoadjuvant chemoradiation; rectal cancer; survival