Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes

Felice, Francesca De; Llange, Karen; Rubini, Filippo; Bulzonetti, Nadia; Caiazzo, Rossella; Musio, Daniela; Tombolini, Vincenzo

doi:10.1016/j.clcc.2017.10.005

Cited by 9 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study reported that the 3-year and estimated 5-year DSS, DFS and LC for patients receiving multimodal therapy were 85.5% and 73.3%, 78.0% and 63.2%, 90.9% and 84.4%, respectively. These results were quite comparable to the previous studies regarding elderly patients [12,[20][21][22]29]. Notably, the oncologic outcomes of our study were not inferior than younger patients in other studies [2,15,21].…”

Section: Discussionsupporting

confidence: 91%

Neoadjuvant chemoradiotherapy followed by surgery benefits patients aged 75 years or older with locally advanced rectal cancer

Liu

Zhang

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: To evaluate the efficacy and treatment related morbidity of neoadjuvant chemoradiotherapy and surgery in elderly patients (aged 75 years or older) with locally advanced rectal cancer (LARC). Methods: We reviewed clinical records of elderly patients with LARC treated with neoadjuvant chemoradiotherapy from January 2008 to June 2017 at our institute. A dose of 45-50Gy in 25 fractions was delivered to pelvis. The primary tumor received a dose of 55Gy concomitantly. The concurrent chemotherapy included capecitabine alone and capecitabine plus oxaliplatin (Xelox). Surgery was performed for suitable patients at least 6 weeks after neoadjuvant treatment. Overall survival (OS), disease specific survival (DSS), disease free survival (DFS) and local control (LC) were calculated with Kaplan-Meier method. Univariate and multivariate analyses were performed with cox proportional hazards model. A two-side value of P<0.05 was defined as statistical significance. Results: A total of 85 patients were enrolled in this study, the median age was 80 years old (range: 75-90 years). After neoadjuvant treatment, surgery was performed in 56 patients (65.9%). Twelve patients (21.4%) obtained pathological complete response (pCR). The incidence of grade 3 or greater acute hematological, gastrointestinal and genitourinary toxicities were 10.7%, 5.2% and 1.8%, respectively. Seven patients (12.5%) experienced postoperative complications. The median follow-up duration was 35.7 months (range: 4.3-100.3 months), The 3-year OS, DSS, DFS and LC were 68.9%, 75.8%, 68.2% and 83.9%, respectively. Surgery was a significant prognostic factor for OS (HR: 10.092, 95%CI: 2.082-36.351, P<0.001), DSS (HR: 4.681, 95%CI: 1.971-11.113, P<0.001), DFS (HR: 5.509, 95%CI: 1.964-15.454, P=0.001) and LC (HR: 3.089, 95%CI: 1.244-11.669, P=0.019). Clinical T downstaging after neoadjuvant treatment was significantly associated with better DFS (HR: 4.554, 95%CI: 1.601-12.958, P=0.004). Conclusion: In patients aged 75 years or older with LARC, neoadjuvant chemoradiotherapy followed by surgery was well tolerated with promising survival outcomes, which should be strongly suggested if medically suitable.

show abstract

Section: Discussionsupporting

confidence: 91%

Neoadjuvant chemoradiotherapy followed by surgery benefits patients aged 75 years or older with locally advanced rectal cancer

Liu

Zhang

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Our study reported that the 3-year and estimated 5-year DSS, DFS and LC for patients receiving multimodal therapy were 75.8% and 60.4%, 68.2% and 56.1%, 83.9% and 78.3%, respectively. These results were quite comparable to the previous studies regarding elderly patients [12,[20][21][22]29]. Notably, the oncologic outcomes of our study were not inferior than younger patients in other studies [2,15,21].…”

Section: Discussionsupporting

confidence: 91%

“…Many studies have reported the incidence of neoadjuvant chemoradiotherapy related toxicity in elderly patients with LARC [12,[19][20][21][22]. Tougeron D, et al [20] retrospectively evaluated safety of chemoradiotherapy in 125 patients with LARC over 70 years, about 15% of enrolled patients developed G3+ adverse events.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer

Liu

Wang²,

et al. 2020

J. Cancer

View full text Add to dashboard Cite

Background: To evaluate the efficacy and treatment related morbidity of neoadjuvant chemoradiotherapy or radiotherapy in elderly patients (aged 75 years or older) with locally advanced rectal cancer (LARC). Methods: We reviewed clinical records of elderly patients with LARC treated with neoadjuvant chemoradiotherapy or radiotherapy between January 2008 and June 2017 at our institute. A dose of 45-50Gy in 25 fractions was delivered to pelvis. The primary tumor received a dose of 55Gy concomitantly for patients receiving intensity modulated radiotherapy (IMRT). The concurrent chemotherapy included capecitabine alone and capecitabine plus oxaliplatin (Xelox). Surgery was performed for suitable patients at least 6 weeks after neoadjuvant treatment. Overall survival (OS), disease specific survival (DSS), disease free survival (DFS) and local control (LC) were calculated with Kaplan-Meier method. Results: A total of 85 patients were enrolled in this study, the median age was 80 years old (range: 75-90 years). After neoadjuvant treatment, surgery was performed in 56 patients (65.9%). Downstaging rate was 85.7% (48/56) with T downstaging in 35 patients (62.5%) and N downstaging in 36 patients (64.3%). Twelve patients (21.4%) obtained pathological complete response (pCR). The incidence of grade 3 or greater acute hematological, gastrointestinal and genitourinary toxicities were 10.7%, 5.2% and 1.8%, respectively. Seven patients (12.5%) experienced postoperative complications. The median follow-up duration was 35.7 months (range: 4.3-100.3 months), The 3-year and 5-year OS, DSS, DFS, LC were 68.9% and 47.2%, 75.8% and 60.4%, 68.2% and 56.1%, 83.9% and 78.3%, respectively. Conclusion: In patients aged 75 years or older with LARC, neoadjuvant chemoradiotherapy followed by surgery was well tolerated with promising survival outcomes, which should be strongly suggested if medically suitable.

show abstract

“…Guimas et al (12), noted an increase in morbidity with the addition of oxaliplatin to standard CRT, and Margalit et al (13), demonstrated that treatment intensification should be performed with care in elderly rectal cancer patients (≥70 years old) treated with preoperative CRT or RT, because the majority of elderly patients required early termination of treatment, treatment interruptions, or dose reductions. On the other hand, several studies showed that neoadjuvant CRT in elderly rectal cancer patients was a well-tolerated treatment without any significant increase in acute and late toxicities (14)(15)(16)(17). In the present study, there was no statistical difference between elderly and younger groups related to the result of neither CRT nor the adverse event during CRT.…”

Section: Discussioncontrasting

confidence: 68%

Clinical outcomes of preoperative chemoradiotherapy in octogenarian with locally advanced rectal cancer

et al. 2019

View full text Add to dashboard Cite

The number of elderly patients who receive surgical treatment for rectal cancer has gradually increased with aging of the population. In recent years, preoperative chemoradiotherapy, followed by surgical treatment, has been widely used for treating patients with locally advanced rectal adenocarcinoma. The aim of the present study was to evaluate if preoperative chemoradiotherapy is efficacious and safe for the treatment of rectal cancer in patients older than 80 years. A total of 293 patients with rectal cancer, who received preoperative chemoradiotherapy from 2007 to 2017, were studied. Comorbidities and the short-and long-term outcomes in elderly patients (aged ≥80 years old) were investigated and compared to younger patients. The elderly group comprised of 17 patients (5.8%). Pulmonary disease was the most common comorbidity (23.5%). No significant difference between the two groups regarding the rate of completeness of chemoradiotherapy was detected (P= 0.26). Curative resection was performed in 14 patients in the elderly group and 252 patients in the younger group. Among 7 patients from both groups who could not receive curative resection due to their poor general condition, 4 patients had decreased lower respiratory function due to pneumonia (3 patients) or chronic obstructive pulmonary disease (1 patient). Morbidity and mortality rates were similar in elderly and younger groups (35.7% vs. 27.0%, 0% vs. 0%, respectively; P=0.54, P=1.00). No significant difference was found regarding recurrence between the two groups (P=1.00). To conclude, preoperative chemoradiotherapy in elderly patients with rectal cancer is safe and well tolerated.

show abstract

Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes

Cited by 9 publications

References 17 publications

Neoadjuvant chemoradiotherapy followed by surgery benefits patients aged 75 years or older with locally advanced rectal cancer

Neoadjuvant chemoradiotherapy followed by surgery benefits patients aged 75 years or older with locally advanced rectal cancer

Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer

Clinical outcomes of preoperative chemoradiotherapy in octogenarian with locally advanced rectal cancer

Contact Info

Product

Resources

About