Adjuvant radiotherapy on older and oldest elderly rectal cancer patients

The purpose of this study was to evaluate the impact of radiotherapy in terms of feasibility and activity inthe patients aged 75 with advanced rectal cancer. FromJanuary 2002 to December 2006, 41 consecutivepatients (27 men and 14 women) aged 75 received radiotherapy for local advanced rectal cancer, 9 in apre-operative and 22 in a post-operative setting. Sixteen patients received concomitant chemotherapy.Variables considered were age, co-morbidities, evaluated according to the adult co-morbidity evaluationindex (ACE-27), surgery versus no surgery, and timing of radiotherapy. The median age was 80.5 years(range 75–90). A total of 19.5% of the patients had no co-morbidity, 48.8% mild, 17.1% moderate, and14.6% had severe co-morbidities. Thirty-nine subjects (95.1%) were submitted to surgery. All patients butone completed the planned radiation schedule. At a median follow-up of 23.1 months, the 2- and 4-yearoverall survival rates were 71.8% and 61.6%, respectively. There was a better survival for patients with noormild co-morbidities (p = 0.002) and a good performance status (p = 0.003). The cancer-free survival at 2and 4 years was 78.9% and 26.4%, respectively. No difference in acute and late toxicity rates was foundbetween patients with different ACE-27 indexes. We conclude that compliance with radiotherapy is goodand rate of toxicity is acceptable in elderly patients. Patients with no or mild co-morbidities have asignificantly better survival. Increasing severity of co-morbidity may sufficiently shorten remaining lifeexpectancy to cancel gains with adjuvant radiotherapy. Further prospective trials are needed to confirmthese results. 2008 Elsevier Ireland Ltd. All rights reserved.