Tolerability and outcomes of radiotherapy or chemoradiotherapy for rectal cancer in elderly patients aged 70 years and older

Radiation Oncology

Zhen Zhang¹  Gang Cai²  Sanjun Cai³  Ji Zhu²  Junjie Peng³  Hongbin Wu¹  Xin Cai¹ 

[1] Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China;Department of Radiological Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, People’s Republic of China;Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China

关键词: Outcome;    Comorbidity;    Radiotherapy;    Elderly;    Rectal cancer;   

Others  :  1154201
DOI  :  10.1186/1748-717X-8-86

 received in 2013-02-23, accepted in 2013-04-07,  发布年份 2013

【 摘 要 】

Purpose

To assess the safety and outcomes of radiotherapy (RT) or chemoradiotherapy (CRT) in elderly patients (≥70) with rectal cancer.

Methods

Elderly patients aged 70 and older with rectal cancer, who were treated with RT or CRT at a single institution, were retrospectively analyzed. Performance status (KPS and ECOG score) and comorbidity (Charlson comorbidity index) were calculated, and their correlation with treatment toxicity and overall survival were studied. Risk factors for overall survival were investigated using univariate and multivariate survival analysis.

Results

A total of 126 patients with locally advanced disease, local recurrence or synchronous metastasis were included, with a 3-year OS rate of 48.1%. Scheduled dosage of radiation was delivered to 69% of patients. Grade 3 toxicities occurred more often in patients treated with CRT versus RT. The occurrence of grade 3 toxicities was not related to KPS score, ECOG score, number of comorbidities, and Charlson score. Multivariate analysis found that only age and Charlson score were independent prognostic factors for predicting patients’ 3-year OS. The 3-year OS rate was significantly higher in patients with Charlson score <4 vs Charlson score ≥4 (71.1% vs. 26.4%, P=0.0003).

Conclusions

Although toxicities may be significant, elderly patients with rectal cancer of varied stages can be safely treated with RT or CRT with careful monitoring and frequent modification of treatment. Except for patients’ age, Charlson comorbidity index may be helpful in assessing patients’ outcomes in elderly patients with rectal cancer.

【 授权许可】

   
2013 Cai et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Shanghai municipal center of disease control and prevention Shanghai Cancer Report: Chinese; 2008.
• [2]Sanoff HK, Carpenter WR, Sturmer T, Goldberg RM, Martin CF, Fine JP, McCleary NJ, Meyerhardt JA, Niland J, Kahn KL: Effect of Adjuvant Chemotherapy on Survival of Patients With Stage III Colon Cancer Diagnosed After Age 75 Years. J Clin Oncol 2012, 30:2624-2634.
• [3]Schag CC, Heinrich RL, Ganz PA: Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol 1984, 2:187-193.
• [4]Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982, 5:649-655.
• [5]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, 40:373-383.
• [6]National Cancer Institute. Common Terminology Criteria for Adverse Events v.3.0(CTCAE)Available at: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf webcite
• [7]Rutten H, den Dulk M, Lemmens V, Nieuwenhuijzen G, Krijnen P: Jansen-Landheer M, van de Poll Franse L, Coebergh JW, Martijn H, Marijnen C, van de Velde C: Survival of elderly rectal cancer patients not improved: analysis of population based data on the impact of TME surgery. Eur J Cancer 2007, 43:2295-2300.
• [8]Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004, 351:1731-1740.
• [9]Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006, 355:1114-1123.
• [10]Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001, 345:638-646.
• [11]Margalit DN, Mamon HJ, Ancukiewicz M, Kobayashi W, Ryan DP, Blaszkowsky LS, Clark J, Willett CG, Hong TS: Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys 2011, 81:e735-741.
• [12]Aparicio T, Navazesh A, Boutron I, Bouarioua N, Chosidow D, Mion M, Choudat L, Sobhani I, Mentre F, Soule JC: Half of elderly patients routinely treated for colorectal cancer receive a sub-standard treatment. Crit Rev Oncol Hematol 2009, 71:249-257.
• [13]Lemmens VE, Janssen-Heijnen ML, Verheij CD, Houterman S: Repelaer van Driel OJ, Coebergh JW: Co-morbidity leads to altered treatment and worse survival of elderly patients with colorectal cancer. Br J Surg 2005, 92:615-623.
• [14]Chang GJ, Skibber JM, Feig BW, Rodriguez-Bigas M: Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg 2007, 246:215-221.
• [15]Janssen-Heijnen ML, Houterman S, Lemmens VE, Louwman MW, Maas HA, Coebergh JW: Prognostic impact of increasing age and co-morbidity in cancer patients: a population-based approach. Crit Rev Oncol Hematol 2005, 55:231-240.
• [16]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, 42:3015-3021.
• [17]van Spronsen DJ, Janssen-Heijnen ML, Lemmens VE, Peters WG, Coebergh JW: Independent prognostic effect of co-morbidity in lymphoma patients: results of the population-based Eindhoven Cancer Registry. Eur J Cancer 2005, 41:1051-1057.
• [18]Louwman WJ, Janssen-Heijnen ML, Houterman S, Voogd AC, van der Sangen MJ, Nieuwenhuijzen GA, Coebergh JW: Less extensive treatment and inferior prognosis for breast cancer patient with comorbidity: a population-based study. Eur J Cancer 2005, 41:779-785.
• [19]Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G: In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care 2006, 44:745-753.
• [20]Goldstein LB, Samsa GP, Matchar DB, Horner RD: Charlson Index comorbidity adjustment for ischemic stroke outcome studies. Stroke 2004, 35:1941-1945.
• [21]Myers RP, Quan H, Hubbard JN, Shaheen AA, Kaplan GG: Predicting in-hospital mortality in patients with cirrhosis: results differ across risk adjustment methods. Hepatology 2009, 49:568-577.
• [22]Tougeron D, Roullet B, Paillot B, Hamidou H, Tourani JM, Bensadoun RJ, Michel P, Silvain C: Safety and outcome of chemoradiotherapy in elderly patients with rectal cancer: results from two French tertiary centres. Dig Liver Dis 2012, 44:350-354.
• [23]Sarfati D, Hill S, Blakely T, Robson B, Purdie G, Dennett E, Cormack D, Dew K: The effect of comorbidity on the use of adjuvant chemotherapy and survival from colon cancer: a retrospective cohort study. BMC Cancer 2009, 9:116. BioMed Central Full Text
• [24]Extermann M, Overcash J, Lyman GH, Parr J, Balducci L: Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998, 16:1582-1587.
• [25]Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M, Parodi S, Dal Lago D, Gioia F, Monfardini S: Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002, 20:494-502.
• [26]Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, Rodin M, Panageas KS, Holland JC, Saltz L: Developing a cancer-specific geriatric assessment: a feasibility study. Cancer 2005, 104:1998-2005.
• [27]Extermann M, Hurria A: Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol 2007, 25:1824-1831.
• [28]Chen CC, Kenefick AL, Tang ST, McCorkle R: Utilization of comprehensive geriatric assessment in cancer patients. Crit Rev Oncol Hematol 2004, 49:53-67.