Perioperative treatment for locally advanced rectal carcinoma (LARC) in elderly patients: Evaluation of compliance, tolerability, and outcome in a Spanish referral institution.

Abstract

e19650 Background: Rectal cancer is a major cause of death. It is known that after 70y old each increment of 5y increases cancer-specific mortality in a 30%. A possible explanation for this poorer outcome relates to a less aggressive treatment approach. Perioperative chemoradiotherapy (CHRT) and radical surgery is the standard of care for LARC. We report a comparative analysis evaluating the compliance, tolerability and outcome of the preoperative treatment for LARC between patients (pts) ≥70y and <70y. Methods: We analyzed pts with LARC from 01/2008 to 10/2009, treated with neoadjuvant CH (5-FU, capecitabine) with concomitant RT (50.4 Gy/1.8 Gy session) or RT alone (5x5 Gy) followed by surgery and adjuvant CH (5FU or Oxaliplatin-based). Two groups were defined (<70y and ≥70y). We comparatively analyzed the following features: ECOG PS, neoadjuvant and adjuvant treatment, compliance, pre-treatment clinical stage, response, toxicity, type of surgery, pathological stage, disease-free (DFS) and overall survival (OS). Results: Ninety-one pts were analyzed (43 <70y, 48 ≥70y), with comparable baseline characteristics: ECOG (p=0.15), stage at diagnosis (p=0.12), and gender (p=0.85). RT was received by 86% and 77% (p=0.27), and CH was added to RT in 77% and 55% in the <70y and in ≥70y groups (p=0.015), respectively. In elderly cohort, 48% of were unable to complete the treatment compared to 24% in the younger group (p= 0.015, OR 1.47, 95% CI: 1.07-2.02) and had higher toxicity risk (p=0.046, OR=2.09, 95%CI: 0.998-4.44). Capecitabine-based CHRT was more used in ≥70y (79% vs 55%, p=0.056). No significant differences in surgery (p=0.63), mesorectal excision (p=0.65), pathological response (p=0.90), positive lymph nodes (p=0.28), DFS (log rank p=0.33) and OS (log rank p=0.58) were seen between the two groups. Adjuvant CH was administered less frequently in elderly pts (p=0.014, OR 1.62, 95%CI: 1.09-2.40). Conclusions: Although pts ≥70y presented a worse compliance of perioperative therapy this did not jeopardize their outcome. Age should not be considered a determining factor when deciding the best treatment option in a multidisciplinary approach.