Feasibility of Image-Guided Radiotherapy for Elderly Patients with Locally Advanced Rectal Cancer

Abstract

PurposeThe study aims to assess the tolerance of elderly patients (70 years or older) with locally advanced rectal cancers to image-guided radiotherapy (IGRT). A retrospective review of 13 elderly patients with locally advanced rectal cancer who underwent preoperative chemoradiation using IGRT was performed. Grade 3–4 acute toxicities, survival, and long-term complications were compared to 17 younger patients (<70 years) with the same disease stage.ResultsGrade 3–4 hematologic toxicities occurred in 7.6% and 0% (p = 0.4) and gastrointestinal toxicities, and, in 15.2% and 5% (p = 0.5), of elderly and younger patients, respectively. Surgery was aborted in three patients, two in the elderly group and one in the younger group. One patient in the elderly group died after surgery from cardiac arrhythmia. After a median follow-up of 34 months, five patients had died, two in the elderly and three in the younger group. The 3-year survival was 90.9% and 87.5% (p = 0.7) for the elderly and younger group respectively. Two patients in the younger group developed ischemic colitis and fecal incontinence. There was no statistically significant difference in acute and late toxicities as well as survival between the two groups.Conclusions and Clinical RelevanceElderly patients with locally advanced rectal cancers may tolerate preoperative chemoradiation with IGRT as well as younger patients. Further prospective studies should be performed to investigate the potential of IGRT for possible cure in elderly patients with locally advanced rectal cancer.

Dose–time fractionation schedules of preoperative radiotherapy and timing to surgery for rectal cancer

“…Given the different combination schemes of dose fractionation and time to surgery, a goal interval of 6–8 weeks is the most commonly used value in clinical trials [Figure 2(a)]. 5,15,17,18,21,24,27,28,31,32,34–36,38–42,44,46–48,50,52,55–94 Moreover, because of factors such as acute radiation reaction, there are some discrepancies between the goal intervals and true intervals. 95 Despite limited samples, a linear correlation can be observed between them in Figure 2(b).…”

Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group

“…At its inception, IGRG was meant to serve as a forum for radiation oncologists to discuss aging and its impact of aging on patient management. However, after multiple collaborative studies resulting in publications on the potential benefits of image-guided radiotherapy (IGRT) for normal organs sparing and improved local control for various types of cancer, the organization has morphed into a special interest and support group for older cancer patients [15,16,17,18]. Many workshops were organized during international cancer conferences.…”

Editorial: Image-Guided Radiotherapy for Effective Radiotherapy Delivery

“…Elderly patients with multiple comorbidities and locally advanced rectal cancer tolerated preoperative chemo-IGRT when compared to younger patients ( 4 ). These preliminary studies suggest that IGRT may become the treatment of choice for elderly cancer patients.…”