Toxicity and outcomes in older versus younger patients treated with trimodality therapy for locally advanced rectal cancer

Materials and Methods

After obtaining institutional review board and research review committee approval, an institutional prospective tumor registry database was queried for patients treated 2004–2016 with trimodality therapy for a pathologically-confirmed diagnosis of rectal adenocarcinoma, American Joint Committee on Cancer8^th edition clinical stage II or III. Trimodality therapy consisted of neoadjuvant long-course radiation therapy to a minimum dose of 45 Gy in 1.8–2 Gy daily fractions with concurrent

Results

A total of 123 patients were included, age 30 to 92 with median follow-up of 43 months. Most patients were male (59.3%) and Caucasian (86.2%), and had clinical Stage II disease (52.8%). Patients were divided into two cohorts, age ≥ 65 and age < 65. The older cohort (41 patients, median age 75), and younger cohort (82 patients, median age 51.5) were well-balanced with respect to gender, race, tumor stage, nodal stage, tumor location, chemotherapy regimen, and radiation technique. However, the

Discussion

Although trimodality therapy is standard of care for the treatment of locally advanced rectal cancer, older patients were not well represented on the trials that established this treatment course. In a recent meta-analysis, the median age of patients included on colorectal cancer clinical trials was approximately 7 years younger than the median age of the colorectal cancer population [5]. Population-based studies have shown that older patients with rectal cancer are treated less often with

Conclusions

This study provides a uniquely comprehensive look at toxicities and outcomes of older versus younger patients treated with trimodality therapy for rectal cancer. Older patients with locally advanced rectal cancer are at risk being either undertreated, potentially leading to a worse oncologic outcome, or being overtreated, potentially causing excess morbidity and mortality. Age itself should not be an exclusion criterion for comprehensive treatment, especially for those who are fit. With

Author contribution

Study concepts: JK Wong, E Handorf, R Jain, H Cooper, J Farma, E Dotan, J Meyer.

Study design: JK Wong, E Handorf, R Jain, H Cooper, J Farma, E Dotan, J Meyer.

Data acquisition: JK Wong, R Jain, E Dotan, J Meyer.

Quality control of data and algorithms: JK Wong, E Handorf, D Lee, R Jain, E Zhang, H Cooper, J Farma, E Dotan, J Meyer.

Data analysis and interpretation: JK Wong, E Handorf, D Lee, R Jain, E Zhang, H Cooper, J Farma, E Dotan, J Meyer.

Statistical analysis: JK Wong, E Handorf, E Dotan, J

Declaration of Competing Interest

The Fox Chase Cancer Center institution is supported by the P30 CA006927 NCI Grant. Dr. Handorf and Dr. Dotan are supported by a Pfizer grant, unrelated to the current research.