Purpose: Neoadjuvant chemoradiation therapy has been considered the preferred treatment option for distal rectal cancer. Studies have shown acceptable tolerability for elderly patients. However, long-term results may be limited by the advanced age and therefore not justify the use of neoadjuvant CRT in this subset of patients. For these reasons we decided to compare outcome of patients undergoing neoadjuvant CRT according to age at diagnosis.
Methods: 401 patients with distal rectal cancer underwent chemoradiation therapy. Tumor response assessment was performed at least 8 weeks from CRT. Patients with complete clinical regression were not immediately operated on. Patients with incomplete clinical response were referred to immediate radical surgery. Outcomes were compared according to age at diagnosis (≥75 vs. <75 years).
Results: Overall, 52 patients (13%) were ≥75 years of age. There were no differences in terms of pre-treatment characteristics, complete clinical response rates, final disease stage, type of operation or recurrence rates between groups (p>0.05). There was a trend towards less systemic recurrences among the elderly population (p=0.051). Overall death rate was similar between elderly patients and those under 75 (23% vs. 18%; p=0.41). However, cancer-related deaths were significantly less frequent in elderly patients (13% vs. 2%; p=0.04). Cancer-specific overall survival (5yr) rates were 96% (≥75) and 85% (<75; p=0.09) while disease-free survival rates were 69% and 61% respectively (p=0.4) after a mean follow-up of 39 months.
Conclusions: Patients over 75 years also benefit from neoadjuvant CRT and surgery for distal rectal cancer in terms of tumor downstaging, complete clinical response, sphincter preservation and survival.