ABSTRACT
BACKGROUND/AIM: Elderly cancer patients are more prevalent and require special attention. This study focused on the outcome of elderly (≥65 years) rectal cancer patients treated with tri-modality therapy. PATIENTS AND METHODS: A total of 105 patients receiving neoadjuvant radio-chemotherapy and resection for locally advanced rectal cancers were retrospectively evaluated. Nine characteristics were analyzed for loco-regional control (LRC), metastases-free survival (MFS) and overall survival (OS) including tumor location, gender, age, performance status, radiotherapy technique, primary tumor/lymph node categories, downstaging and histological grading. RESULTS: The 5-year rates of LRC, MFS and OS were 91%, 78% and 87%, respectively. Radio-chemotherapy was not completed in 12 patients (11%) due to toxicity; 18 patients (17%) experienced grade 3 toxicities. A total of 29 patients (28%) had surgical complications. On multivariate analyses, MFS was significantly associated with downstaging (p=0.003) and OS with lower histological grade (p=0.013). CONCLUSION: Tri-modality therapy resulted in promising outcomes and was tolerated reasonably well by elderly patients. Prognostic factors were identified that may help personalize future treatment.
Subject(s)
Rectal Neoplasms/therapy , Age Factors , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bevacizumab/administration & dosage , Capecitabine/administration & dosage , Chemoradiotherapy, Adjuvant/adverse effects , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Disease-Free Survival , Female , Fluorouracil/administration & dosage , Humans , Karnofsky Performance Status , Male , Neoplasm Grading , Neoplasm Staging , Oxaliplatin/administration & dosage , Postoperative Complications , Rectal Neoplasms/mortality , Rectal Neoplasms/pathology , Retrospective Studies , Sex Factors , Treatment OutcomeABSTRACT
BACKGROUND/AIM: The value of neoadjuvant radiochemotherapy for high rectal cancers is controversial. This study compared surgery plus neoadjuvant radiochemotherapy to surgery alone. PATIENTS AND METHODS: Fifty-two patients with stage II/III high rectal cancers treated with surgery plus neoadjuvant radiochemotherapy were matched (1:4) to 208 patients treated with surgery alone. Matching criteria included age (≤65 vs. >65 years), gender and UICC-stage (II vs. III). These criteria were identical in all five patients used for each 1:4 matching. Both groups were compared for overall survival (OS). RESULTS: On univariate analyses, age ≤65 years (p<0.001) was significantly associated with improved OS. A trend towards improved OS was found for neoadjuvant radiochemotherapy (p=0.078) and UICC-stage II (p=0.060). On multivariate analysis, age (p<0.001) remained significant, and neoadjuvant radiochemotherapy showed a trend towards better OS (p=0.073). CONCLUSION: Given the limitations of this study, the results showed that neoadjuvant radiochemotherapy may improve OS in patients with stage II/III high rectal cancers. However, these results need to be verified in a prospective randomized trial.
Subject(s)
Chemoradiotherapy , Digestive System Surgical Procedures , Rectal Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Case-Control Studies , Combined Modality Therapy , Female , Humans , Male , Matched-Pair Analysis , Middle Aged , Neoadjuvant Therapy , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Retrospective StudiesABSTRACT
BACKGROUND/AIM: Treatment for high rectal cancers, particularly the value of preoperative treatment, is controversial. In our previous study, downstaging by preoperative chemoradiation resulted in improved outcomes. The aim of the present study was to identify prognostic factors to predict which patients will achieve downstaging and may benefit from preoperative treatment. PATIENTS AND METHODS: In 54 patients with locally advanced non-metastatic high rectal cancer, 8 factors were evaluated for downstaging by preoperative chemoradiation including age, gender, carcinoembryonic antigen level, performance status, T-/N-category, UICC-stage (Union for International Cancer Control) and histological grade. Downstaging was defined as decrease by at least one UICC-stage. RESULTS: Downstaging was achieved in 36 patients (67%). Patients at UICC-stage III showed a trend for downstaging. CONCLUSION: The majority of patients with UICC-stage III tumors were downstaged and appear to benefit from preoperative chemoradiation. In general, the potential value of preoperative treatment for high rectal cancers needs further investigation.
Subject(s)
Prognosis , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor , Chemoradiotherapy , Disease-Free Survival , Female , Humans , Lymphatic Metastasis , Male , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Rectal Neoplasms/pathology , Treatment OutcomeABSTRACT
BACKGROUND/AIM: Controversy exists regarding treatment of high rectal cancer. The role of neoadjuvant radio-chemotherapy was investigated. PATIENTS AND METHODS: Fifty-four patients receiving neoadjuvant radio-chemotherapy (50.4 Gy & 2 courses of concurrent chemotherapy) for stage II/III high rectal cancer (10.1-15.0 cm from anal verge) were retrospectively analyzed. Following microscopicallly complete resection of primary tumor and involved lymph nodes in all patients, ≤6 courses of chemotherapy were given. RESULTS: Five-year rates of local control (LC), metastases-free survival (MFS) and overall survival (OS) were 90%, 79% and 77%. On multivariate analyses, LC was associated with lower pathological UICC-stage at surgery (p=0.003) and successful downstaging (p=0.007), MFS with higher regression grade (p=0.014) and OS with lower Union for International Cancer Control (UICC)-stage (p=0.017) and downstaging (p=0.034). Grade 3 acute toxicities occurred in 19% of patients; grade ≥3 late toxicities were not observed. Manageable surgery-related complications occurred in 43%. CONCLUSION: Neoadjuvant radio-chemotherapy for high rectal cancer was well tolerated and led to promising results. Comparative studies are required to investigate whether it is superior to postoperative chemotherapy alone.