AIM To evaluate treatment-related toxicity, treatment compliance, surgical complications and event-free survival (EFS) in older (≥70 years) versus younger (<70 years) adults who underwent perioperative treatment for gastric cancer. METHODS In the CRITICS trial, 788 patients with resectable gastric cancer were randomised before start of any treatment and received preoperative chemotherapy (3 cycles of epirubicin, cisplatin or oxaliplatin and capecitabine), followed by surgery, followed by either postoperative chemotherapy or chemoradiotherapy (45Gy + cisplatin + capecitabine). RESULTS 172 (22%) patients were older adults. During preoperative chemotherapy, 131 (77%) older adults versus 380 (62%) younger adults experienced severe toxicity (p < 0.001); older adults received significantly lower relative dose intensities (RDIs) for all chemotherapeutic drugs. Equal proportions of older versus younger adults underwent curative surgery: 137 (80%) versus 499 (81%), with comparable postoperative complications and postoperative mortality. Postoperative therapy after curative surgery started in 87 (64%) older adults versus 391 (78%) younger adults (p < 0.001). Incidence of severe toxicity during postoperative chemotherapy was 22 (54%) in older adults versus 113 (59%) in younger adults (p = 0.541); older adults received significantly lower RDIs for all chemotherapeutic drugs. Severe toxicity rates for postoperative chemoradiotherapy were 22 (48%) older adults versus 89 (45%) for younger adults (p = 0.703), with comparable chemotherapy RDIs and radiotherapy dose. Two-year EFS was 53% for older adults versus 51% for younger adults. CONCLUSION Perioperative treatment compliance, especially in the postoperative phase, was poorer in older adults compared with younger adults. As comparable proportions of patients underwent curative surgery, future studies should focus on neo-adjuvant treatment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00407186. EudraCT number: 2006-00413032.

中文翻译：

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接受围手术期治疗的老年胃癌患者：CRITICS试验的结果。

目的评估接受胃癌围手术期治疗的年龄较大（≥70岁）和年轻人（小于70岁）成年人的治疗相关毒性，治疗依从性，手术并发症和无事件生存率（EFS）。方法在CRITICS试验中，将788例可切除的胃癌患者在开始任何治疗之前随机分组，并接受术前化疗（3个周期的表柔比星，顺铂或奥沙利铂和卡培他滨），然后进行手术，然后进行术后化疗或放化疗（45Gy +顺铂+卡培他滨）。结果172名（22％）患者为老年人。在术前化疗期间，有131名（77％）的成年人和380名（62％）的年轻人经历了严重的毒性反应（p <0.001）；老年人接受所有化疗药物的相对剂量强度（RDI）明显较低。老年人和年轻人中，接受根治性手术的比例相等：137（80％）对499（81％），术后并发症和术后死亡率相当。治愈性手术后的87岁（64％）成年人开始进行术后治疗，而391岁（78％）的年轻人开始进行术后治疗（p <0.001）。老年人化疗后发生严重毒性反应的发生率为22（54％），而年轻人为113（59％）（p = 0.541）；老年人接受所有化学治疗药物的RDI明显降低。术后放化疗的严重毒性率为22岁（48％）的成年人，而较年轻的成年人为89％（45％）（p = 0.703），具有可比的化疗RDI和放疗剂量。老年人的两年EFS为53％，而年轻人为51％。结论与年轻人相比，老年人的围手术期治疗依从性较差，尤其是在术后阶段。由于相当比例的患者接受了根治性手术，因此未来的研究应侧重于新辅助治疗。试验注册ClinicalTrials.gov标识符：NCT00407186。EudraCT编号：2006-00413032。