Survival outcome of operated and non-operated elderly patients with rectal cancer: A Surveillance, Epidemiology, and End Results analysis

Bhangu, Aneel; Kiran, Ravi P.; Audisio, Riccardo A.; Tekkis, Paris

doi:10.1016/j.ejso.2014.02.239

Cited by 28 publications

(26 citation statements)

References 27 publications

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“…A retrospective review of patients in our unit with colorectal cancer who did not undergo surgery showed that a reasonable proportion went on to live for several years almost reaching the average life expectancy for this age group. The diagnosis of cancer made little difference to the overall survival, as was reported by other retrospective studies analysing data from the American Surveillance, Epidemiology and End Results (SEER) Medicare database . As patients age their overall survival compared with younger patients falls rapidly, but for cancer‐specific survival this is less marked.…”

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confidence: 66%

What happens when we don't operate?

Bethune¹,

Arulampalam²

2015

Colorectal Disease

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confidence: 66%

What happens when we don't operate?

Bethune¹,

Arulampalam²

2015

Colorectal Disease

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“…The best treatment option for elderly patients with LARC remained controversial due to lacking in prospective clinical data [16,17]. Though neoadjuvant chemoradiotherapy combined with TME surgery is the current standard treatment, many elderly patients can't finish the whole treatment procedure because of comorbidities, treatment related morbidities and other personal reasons [7,9,16,[18][19][20]. Our study enrolled 85 patients at least 75 years with LARC.…”

Section: Discussionmentioning

confidence: 99%

“…There is another key point that should not be ignored. With increasing age, more patients would die from other comorbidities [7], such as cardiovascular, nervous system and pulmonary diseases. Eight patients died of comorbidities instead of rectal cancer, accounting for 25.8% of all deceased in our study.…”

Section: Discussionmentioning

confidence: 99%

“…As life expectancy increases, more and more elderly people suffer from rectal cancer [6]. With the increasing age, patients are more prone to suffer comorbidities and treatment related morbidities [7][8][9][10]. In a retrospective study [11], patients older than 75 years had worsen comorbidity status and more medical complications than those younger than 75 years.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Wang²,

et al. 2020

J. Cancer

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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.

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“…Rectal cancer mainly occurs in elderly patients, with peak incidence at age of 80-85 years old [6]. With the increasing age, patients are more prone to suffer comorbidities and treatment related morbidities [7][8][9][10]. In a retrospective study [11], patients older than 75 years had worsen comorbidity status and more medical complications than those younger than 75 years.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Zhang

et al. 2019

Preprint

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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.

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Survival outcome of operated and non-operated elderly patients with rectal cancer: A Surveillance, Epidemiology, and End Results analysis

Cited by 28 publications

References 27 publications

What happens when we don't operate?

What happens when we don't operate?

Neoadjuvant chemoradiotherapy or radiotherapy in 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

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