Neoadyuvant radiochemotherapy for elder patients with stage II-III rectal cancer

Abstract

20531 Background: Rectal cancer incidence increase with age. Neoadyuvant radiochemotherapy is the standard treatment for locally advanced rectal cancer. Due to the fact that management of cancer in elderly is difficult because of age related conditions, we investigated the efficacy and safety profile of this treatment for stages II-III rectal cancer among elderly. Methods: Between January 1999 and July 2007,134 patients older than 70 years out of a total of 300 consecutive cases with locally advanced rectal adenocarcinoma (stage II: 25%; stage III: 75%) were treated with neoadyuvant conformational radiochemotherapy. Median age was 75 years (range 70–87) and they were in acceptable clinical condition (ECOG 0–1). The treatment consisted in radiation therapy up to a median total dose of 50 Gy (range 4,500–5,940 cGy) delivered using a conformational technique concomitant with 5-FU by continuous i.v. infusion (54 %), 5-FU bolus according to Mayo Clinic (20%), UFT oral (25%) and capecitabine (1%). Toxicity was scored according to CTCAE scale during the chemoradiation administration. Between radiotherapy and surgery the mean time was 7± 2,6 weeks, abdominoperineal resection was performed in 58 patients (43%) and anterior resection in 74 patients (55%). Results: 126 patients were able to support entire treatment (94%). 71% patients had downstaging (T y N downstaging was 70% and 71% respectively) and pathologic complete response were observed in 28 patients (21%). Pathologic stage were I in 40 patients (30%), II in 39 patients (29%) and III in 22 patients (16%). The majority adverse events were mild to moderate and grade 1–2 proctitis was the most common. Gastrointestinal acute toxicity grade 3–4 ocurred in 5 patients and haematological acute grade 3–4 were neutropenia in 2 patients. Conclusions: Neoadyuvant radiochemotherapy in elder patients with rectal cancer is effective and is well tolerated. Our data support to treat these patients depending on their performance status not on age. No significant financial relationships to disclose.