Skip to main content
Top
Published in: Surgery Today 8/2019

01-08-2019 | Rectal Cancer | Original Article

Feasibility of neoadjuvant therapy for elderly patients with locally advanced rectal cancer

Authors: Tetsuro Tominaga, Toshiya Nagasaki, Takashi Akiyoshi, Yosuke Fukunaga, Yoshiya Fujimoto, Tomohiro Yamaguchi, Tsuyoshi Konishi, Satoshi Nagayama, Masashi Ueno

Published in: Surgery Today | Issue 8/2019

Login to get access

Abstract

Purpose

The feasibility of neoadjuvant therapy (NAT) for elderly patients with rectal cancer has not been evaluated well.

Methods

Between 2004 and 2014, 506 patients with locally advanced low rectal cancer underwent curative resection. Fifty-four were over 75 years old (elderly group), and 452 were under 75 years old (young group). The patients were divided into sub-groups according to whether they received NAT.

Results

Nineteen (35.2%) patients from the elderly group and 348 (77.0%) from the young group received NAT. The proportion of patients who received NAT was significantly lower in the elderly group. In the elderly group, the median age and prevalence of co-morbidities were significantly lower in patients with than in those without NAT. The incidence of severe adverse events was similar in the two groups. On multivariate analysis, age was not related to postoperative complications in patients who received NAT. The 5-year local recurrence rate was significantly lower in the elderly patients who received NAT, and similar to that of the young patients who received NAT.

Conclusions

Neoadjuvant therapy was feasible and should be considered as a treatment option for carefully selected elderly patients with locally advanced low rectal cancer.
Literature
1.
go back to reference Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.CrossRefPubMed Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.CrossRefPubMed
2.
go back to reference Breugom AJ, Van Gijn W, Muller EW, Berglund A, van den Broek CBM, Fokstuen T, et al. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015;26:696–701.CrossRefPubMed Breugom AJ, Van Gijn W, Muller EW, Berglund A, van den Broek CBM, Fokstuen T, et al. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015;26:696–701.CrossRefPubMed
3.
go back to reference Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.CrossRefPubMed Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish rectal cancer trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.CrossRefPubMed
4.
go back to reference Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2016;23:1–34.CrossRef Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. 2016;23:1–34.CrossRef
5.
go back to reference Kotake K, Asano M, Ozawa H, Kobayashi H, Sugihara K. Tumour characteristics, treatment patterns and survival of patients aged 80 years or older with colorectal cancer. Colorectal Dis. 2015;17:205–15.CrossRefPubMed Kotake K, Asano M, Ozawa H, Kobayashi H, Sugihara K. Tumour characteristics, treatment patterns and survival of patients aged 80 years or older with colorectal cancer. Colorectal Dis. 2015;17:205–15.CrossRefPubMed
6.
go back to reference Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.CrossRefPubMed Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56:106–30.CrossRefPubMed
7.
go back to reference Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group. Cancer incidence and incidence rates in Japan in a study of 25 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2008;2014(44):388–96. Matsuda A, Matsuda T, Shibata A, Katanoda K, Sobue T, Nishimoto H, Japan Cancer Surveillance Research Group. Cancer incidence and incidence rates in Japan in a study of 25 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2008;2014(44):388–96.
8.
go back to reference Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.CrossRefPubMed Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.CrossRefPubMed
9.
go back to reference Bohac GC, Guaqueta D, Cheng DM, Aschengrau A, Hartshorn KL. Disparity in the use of combined modality therapy for rectal cancer in the older adult. J Geriatr Oncol. 2013;4:90–7.CrossRefPubMed Bohac GC, Guaqueta D, Cheng DM, Aschengrau A, Hartshorn KL. Disparity in the use of combined modality therapy for rectal cancer in the older adult. J Geriatr Oncol. 2013;4:90–7.CrossRefPubMed
10.
go back to reference Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.CrossRefPubMed Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006;24:4620–5.CrossRefPubMed
11.
go back to reference Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Pudelko M, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004;72:15–24.CrossRefPubMed Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Pudelko M, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol. 2004;72:15–24.CrossRefPubMed
12.
go back to reference Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Prognostic impact of neutrophil-to-lymphocyte ratio in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy. Dig Surg. 2015;32:496–503.CrossRefPubMed Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Prognostic impact of neutrophil-to-lymphocyte ratio in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy. Dig Surg. 2015;32:496–503.CrossRefPubMed
13.
go back to reference Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Preoperative chemoradiotherapy might improve the prognosis of patients with locally advanced low rectal cancer and lateral pelvic lymph node metastases. World J Surg. 2017;41:876–83.CrossRefPubMed Nagasaki T, Akiyoshi T, Fujimoto Y, Konishi T, Nagayama S, Fukunaga Y, et al. Preoperative chemoradiotherapy might improve the prognosis of patients with locally advanced low rectal cancer and lateral pelvic lymph node metastases. World J Surg. 2017;41:876–83.CrossRefPubMed
14.
go back to reference Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 2014;21:189–96.CrossRefPubMed Akiyoshi T, Ueno M, Matsueda K, Konishi T, Fujimoto Y, Nagayama S, et al. Selective lateral pelvic lymph node dissection in patients with advanced low rectal cancer treated with preoperative chemoradiotherapy based on pretreatment imaging. Ann Surg Oncol. 2014;21:189–96.CrossRefPubMed
16.
go back to reference Balducci L. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.CrossRefPubMed Balducci L. Management of cancer in the older person: a practical approach. Oncologist. 2000;5:224–37.CrossRefPubMed
17.
go back to reference Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, et al. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol. 2015;26:463–76.CrossRefPubMed Papamichael D, Audisio RA, Glimelius B, de Gramont A, Glynne-Jones R, Haller D, et al. Treatment of colorectal cancer in older patients: International Society of Geriatric Oncology (SIOG) consensus recommendations 2013. Ann Oncol. 2015;26:463–76.CrossRefPubMed
18.
go back to reference Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118:3377–86.CrossRefPubMed Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118:3377–86.CrossRefPubMed
19.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMed
20.
go back to reference Cai X, Wu H, Peng J, Zhu J, Cai S, Cai G, et al. Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older. Radiat Oncol. 2013;8:86.CrossRefPubMedPubMedCentral Cai X, Wu H, Peng J, Zhu J, Cai S, Cai G, et al. Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older. Radiat Oncol. 2013;8:86.CrossRefPubMedPubMedCentral
21.
go back to reference Tougeron D, Roullet B, Paillot B, Hamidou H, Tourani J, Bensadoun R, et al. Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer : results from two French tertiary centres. Dig Liver Dis. 2012;44:350–4.CrossRefPubMed Tougeron D, Roullet B, Paillot B, Hamidou H, Tourani J, Bensadoun R, et al. Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer : results from two French tertiary centres. Dig Liver Dis. 2012;44:350–4.CrossRefPubMed
22.
go back to reference Suhool A, Moszkowicz D, Cudennec T, Vychnevskaia K, Malafosse R, Beauchet A, et al. Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg. 2018;155:17–25.CrossRefPubMed Suhool A, Moszkowicz D, Cudennec T, Vychnevskaia K, Malafosse R, Beauchet A, et al. Optimal oncologic treatment of rectal cancer in patients over 75 years old: results of a strategy based on oncogeriatric evaluation. J Visc Surg. 2018;155:17–25.CrossRefPubMed
23.
go back to reference Ausili Cèfaro G, Genovesi D, Vinciguerra A, Augurio A, Di Tommaso M, Marchese R, et al. Effects of preoperative radiochemotherapy with capecitabine for resectable locally advanced rectal cancer in elderly patients. Tumori. 2012;98:622–9.CrossRefPubMed Ausili Cèfaro G, Genovesi D, Vinciguerra A, Augurio A, Di Tommaso M, Marchese R, et al. Effects of preoperative radiochemotherapy with capecitabine for resectable locally advanced rectal cancer in elderly patients. Tumori. 2012;98:622–9.CrossRefPubMed
24.
go back to reference François E, Azria D, Gourgou-Bourgade S, Jarlier M, Martel-Laffay I, Hennequin C, et al. Results in the elderly with locally advanced rectal cancer from the ACCOR12/PRODIGE 2 phase III trial: tolerance and efficacy. Radiother Oncol. 2014;110:144–9.CrossRefPubMed François E, Azria D, Gourgou-Bourgade S, Jarlier M, Martel-Laffay I, Hennequin C, et al. Results in the elderly with locally advanced rectal cancer from the ACCOR12/PRODIGE 2 phase III trial: tolerance and efficacy. Radiother Oncol. 2014;110:144–9.CrossRefPubMed
25.
go back to reference Choi Y, Kim JH, Kim J-W, Kim JW, Lee K-W, Oh H-K, et al. Preoperative chemoradiotherapy for elderly patients with locally advanced rectal cancer-a real-world outcome study. Jpn J Clin Oncol. 2016;46:1108–17.CrossRefPubMed Choi Y, Kim JH, Kim J-W, Kim JW, Lee K-W, Oh H-K, et al. Preoperative chemoradiotherapy for elderly patients with locally advanced rectal cancer-a real-world outcome study. Jpn J Clin Oncol. 2016;46:1108–17.CrossRefPubMed
26.
go back to reference Jiang DM, Raissouni S, Mercer J, Kumar A, Goodwin R, Heng DY, et al. Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer. Ann Oncol. 2015;26:2102–6.CrossRefPubMed Jiang DM, Raissouni S, Mercer J, Kumar A, Goodwin R, Heng DY, et al. Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer. Ann Oncol. 2015;26:2102–6.CrossRefPubMed
27.
go back to reference Pasetto LM, Friso ML, Pucciarelli S, Basso U, Falci C, Bortolami A, et al. Rectal cancer neoadjuvant treatment in elderly patients. Anticancer Res. 2006;26:3913–23.PubMed Pasetto LM, Friso ML, Pucciarelli S, Basso U, Falci C, Bortolami A, et al. Rectal cancer neoadjuvant treatment in elderly patients. Anticancer Res. 2006;26:3913–23.PubMed
28.
go back to reference Jung B, Påhlman L, Johansson R, Nilsson E. Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004. BMC Cancer. 2009;9:1–8.CrossRef Jung B, Påhlman L, Johansson R, Nilsson E. Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004. BMC Cancer. 2009;9:1–8.CrossRef
29.
go back to reference Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen-Heijnen ML. Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer. 2006;42:3015–21.CrossRefPubMed Shahir MA, Lemmens VE, van de Poll-Franse LV, Voogd AC, Martijn H, Janssen-Heijnen ML. Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer. 2006;42:3015–21.CrossRefPubMed
30.
go back to reference Perez DL, Caceres AN, Toscano NA, Casal NJ. Results of colon cancer surgery in patients over 75 years old. ANZ J Surg. 2018;88:11–5.CrossRef Perez DL, Caceres AN, Toscano NA, Casal NJ. Results of colon cancer surgery in patients over 75 years old. ANZ J Surg. 2018;88:11–5.CrossRef
31.
go back to reference Abbott RD, Donahue RP, Kannel WB, Wilson PW. The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study. JAMA. 1988;260:3456–60.CrossRefPubMed Abbott RD, Donahue RP, Kannel WB, Wilson PW. The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study. JAMA. 1988;260:3456–60.CrossRefPubMed
32.
go back to reference Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.CrossRefPubMedPubMedCentral Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.CrossRefPubMedPubMedCentral
Metadata
Title
Feasibility of neoadjuvant therapy for elderly patients with locally advanced rectal cancer
Authors
Tetsuro Tominaga
Toshiya Nagasaki
Takashi Akiyoshi
Yosuke Fukunaga
Yoshiya Fujimoto
Tomohiro Yamaguchi
Tsuyoshi Konishi
Satoshi Nagayama
Masashi Ueno
Publication date
01-08-2019
Publisher
Springer Singapore
Published in
Surgery Today / Issue 8/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01801-0

Other articles of this Issue 8/2019

Surgery Today 8/2019 Go to the issue