Abstract
Patients were excluded if they were older than 75 years of age in most clinical trials. Thus, the optimal treatment strategies in elderly patients with locally advanced rectal cancer (LARC) are still controversial. We designed our study to specifically evaluate the cancer specific survival of four subgroups of patients according to four different treatment modalities: surgery only, radiation (RT) only, neoadjuvant RT and adjuvant RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. The results showed that the 5-year cancer specific survival (CSS) was 52.1% in surgery only, 27.7% in RT only, 70.4% in neoadjuvant RT and 60.4% in adjuvant RT, which had significant difference in univariate log-rank test (P < 0.001) and multivariate Cox regression (P < 0.001). Thus, the neoadjuvant RT and surgery may be the optimal treatment pattern in elderly patients, especially for patients who are medically fit for the operation.
Highlights
Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is a standard treatment in patients aged 75 years and younger with locally advanced rectal cancer (LARC) [1,2,3,4,5]
We designed our study to evaluate the cancer specific survival of four subgroups of patients according to four different treatment modalities: surgery only, radiation (RT) only, neoadjuvant RT and adjuvant RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database
We identified 4,121 eligible elderly patients with LARC in SEER database during the 8-year study period, which included 1460 patients in surgery only, 577 patients in RT only, 1498 patients in neoadjuvant RT and 586 patients in adjuvant RT
Summary
Neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision (TME) is a standard treatment in patients aged 75 years and younger with locally advanced rectal cancer (LARC) [1,2,3,4,5]. Patients were excluded if they were older than 75 years of age in most clinical trials. Patients are more likely to have other concomitant chronic illnesses, which may increase the risk of complications and even death during treatment. The optimal treatment strategies in elderly patients are still controversial. We designed our study to evaluate the cancer specific survival of four subgroups of patients according to four different treatment modalities: surgery only, radiation (RT) only, neoadjuvant RT and adjuvant RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database
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