Sirs, We read with interest Bouvier's paper, ‘Trends in the Management and Survival of Digestive Tract Cancers among Patients Aged over 80 years’, in the recent issue of Alimentary Pharmacology and Therapeutics.1 They showed the trends in the treatment of digestive tract cancers among patients aged ≥80 years. They examined time trends in three age classes and in five 4-year time intervals. Analysing postoperative survival rates for various cancers in the digestive tract, they concluded that surgery should not be restricted on the basis of age alone and further improvements can be made in particular to enhance adjuvant therapy whenever possible. In their analysis, the proportion of patients with rectal cancer receiving adjuvant radiotherapy slightly increased without reaching 20% during the last time period. They stated that comorbidity and advanced age are the more commonly cited reasons for not administering adjuvant therapies in patients with rectal cancer aged ≥75 years than patient refusal. However, although Bouvier et al. 1 addressed the importance of adjuvant therapy to improve surgical outcome, their study did not provide any specific data concerning complications related with adjuvant therapy in the treatment of rectal cancer. In the treatment of rectal cancer, we have a similar study and agree with their conclusion supporting the application of the surgical treatment for elderly patients. Furthermore, concerning adjuvant radiotherapy, we recently demonstrated that neoadjuvant radiotherapy is a safe modality for elderly patients.2 We examined a total of 230 patients with T3/T4 rectal cancer who underwent preoperative radiotherapy. According to age, patients were divided into elderly group (≥70 years: n = 44) or younger group (<70 years old: n = 186). Between two groups, there was no significant difference in curative resection rate, sphincter-preserving rate, 5-year cumulative relapse-free survival rate or 5-year cumulative local recurrence-free survival rate. Furthermore, as for adverse effects, the frequency of grade 4 radiation toxicity or grade l–3 toxicity, including nausea, fatigue, diarrhoea and dermatitis, showed no statistical difference between two groups. Postoperative mortality was 0% in both groups and postoperative morbidity rate was 58.5% in the elderly group and 50.8% in the younger group (N.S.). Postoperative major complications occurred in 9.8% in elderly group and 7.7% in younger group (N.S.). All these results showed no significant disadvantage by adjuvant radiotherapy in elderly patients. Considering that the incidence of adverse events in relation with radiotherapy did not increase in elderly patients, together with Bouvier's results, it is suggested that adjuvant radiotherapy is a safe modality for rectal cancer in elderly patients.