J Cancer 2020; 11(12):3536-3542. doi:10.7150/jca.41950

Research Paper

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

Xiaoliang Liu1, Junjie Wang2, Ke Hu1*✉, Fuquan Zhang1*✉, Xiaorong Hou1, Yi Xiao3, Xin Lian1, Shuai Sun1, Zhikai Liu1, Junfang Yan1, Zheng Miao1

1. Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China.
2. Department of Gynecological Oncology, Qingdao Center Hospital, Qingdao, Shandong, the People's Republic of China.
3. Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China.
*Ke Hu and Fuquan Zhang contributed equally to this work.

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Citation:
Liu X, Wang J, Hu K, Zhang F, Hou X, Xiao Y, Lian X, Sun S, Liu Z, Yan J, Miao Z. Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer. J Cancer 2020; 11(12):3536-3542. doi:10.7150/jca.41950. Available from http://www.jcancer.org/v11p3536.htm

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Abstract

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.

Keywords: rectal cancer, elderly, neoadjuvant, radiotherapy, chemotherapy