1
|
Abstract
OBJECTIVES Oncological treatments of older patients have many unresolved questions mainly because of the fact that these patients were not eligible to be included in most clinical trials. The aim of this study was to evaluate the treatment approach to localized rectal cancer in the older population, including complication rates and overall survival in patients treated with curative intent. MATERIALS AND METHODS A retrospective review of patients older than 80 years old (group A) who were treated for clinical stages II to III rectal cancer. The data collection included demographics, comorbidities, treatment protocols, adverse events, time of death, and a comparison with a group of patients aged 65 to 75 years (group B). RESULTS A total of 88 patients were included in the analysis (group A, 35; group B, 53). The groups were balanced with regards to sex, comorbidities, pretreatment albumin, and hemoglobin levels (for all categories P>0.05). More patients in group A (25%) received preoperative treatment as in-patients (P=0.022) and were treated with radiation only (P<0.0001) as the initial treatment approach. In group A, in 82% of patients the initial chemotherapy dose was reduced to 75% or less of the calculated dose compared with 7% in group B (P<0.001). Discontinuation of chemotherapy was needed in 55% in group A and 31% in group B (P=0.07). Median overall survival was 33 months in group A and 55 months in group B (P=0.06), 5-year overall survival was 27% and 60%, respectively (P=0.004). CONCLUSIONS The age has a significant implication on preoperative treatment, chemotherapy dose, hospitalization rates, and survival.
Collapse
|
2
|
In Response to Yavas G and Yavas C on Comment on “Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes”. Clin Colorectal Cancer 2020; 19:e70. [DOI: 10.1016/j.clcc.2020.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/01/2020] [Indexed: 11/19/2022]
|
3
|
van der Valk MJM, van der Sande ME, Toebes RE, Breukink SO, Bröker MEE, Doornebosch PG, Maliko N, Neijenhuis PA, Marinelli AWKS, Peters FP, Peeters KCMJ, Beets GL, Marang-van de Mheen PJ, Hilling DE. Importance of patient reported and clinical outcomes for patients with locally advanced rectal cancer and their treating physicians. Do clinicians know what patients want? Eur J Surg Oncol 2020; 46:1634-1641. [PMID: 32336626 DOI: 10.1016/j.ejso.2020.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/29/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Several factors are included in decision making for treatment of patients with locally advanced rectal cancer, including a trade-off between risks and gains of both clinical and functional outcomes. However, it is largely unknown which outcomes are most important to patients and whether this differs between patients and clinicians. METHODS Both clinicians and patients treated for locally advanced rectal cancer were invited to fill out an online questionnaire, including a choice-based conjoint experiment. Participants were presented 14 comparisons of two hypothetical case presentations, characterized by different treatments and outcomes of care (6 attributes) and were asked to select the case with the best outcome at that moment. Hierarchical Bayes Estimation was used to calculate the relative importance (RI) of each of the six attributes. RESULTS In total, 94 patients and 128 clinicians completed the questionnaire. For patients, avoiding surgery with permanent stoma was most important (RI 24.4, 95%CI 21.88-26.87) and a 2-year difference in disease-free survival was least important (RI 5.6, 95%CI 4.9-6.2). Clinicians assigned highest importance to avoiding severe and daily worries about cancer recurrence (RI 30.7, 95%CI 29.1-32.4), while this was ranked 4th by patients (RI 17.9, 95%CI 16.5-19.4, p < 0.001). CONCLUSION When confronted with different outcomes within one case description, patients find the duration of disease free survival the least important. In addition, considerable differences were found between the importance assigned by patients and clinicians to clinical and functional outcomes, most notably in avoiding surgery with permanent stoma and worries about recurrence.
Collapse
Affiliation(s)
- Maxime J M van der Valk
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands.
| | - Marit E van der Sande
- Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands
| | - Renee E Toebes
- Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
| | - Mirelle E E Bröker
- Department of Surgery, IJsselland Hospital, Capelle a/d IJssel, the Netherlands
| | | | - Nansi Maliko
- Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands
| | | | | | - Femke P Peters
- Department of Radiotherapy, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands; Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Geerard L Beets
- Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Denise E Hilling
- Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands; Department of Surgery, Antoni van Leeuwenhoek-National Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Liu X, Wang J, Hu K, Zhang F, Hou X, Xiao Y, Lian X, Sun S, Liu Z, Yan J, Miao Z. Neoadjuvant chemoradiotherapy or radiotherapy in patients aged 75 years or older with locally advanced rectal cancer. J Cancer 2020; 11:3536-3542. [PMID: 32284749 PMCID: PMC7150442 DOI: 10.7150/jca.41950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/26/2020] [Indexed: 12/22/2022] Open
Abstract
Background: To evaluate the efficacy and treatment related morbidity of neoadjuvant chemoradiotherapy or radiotherapy in elderly patients (aged 75 years or older) with locally advanced rectal cancer (LARC). Methods: We reviewed clinical records of elderly patients with LARC treated with neoadjuvant chemoradiotherapy or radiotherapy between January 2008 and June 2017 at our institute. A dose of 45-50Gy in 25 fractions was delivered to pelvis. The primary tumor received a dose of 55Gy concomitantly for patients receiving intensity modulated radiotherapy (IMRT). The concurrent chemotherapy included capecitabine alone and capecitabine plus oxaliplatin (Xelox). Surgery was performed for suitable patients at least 6 weeks after neoadjuvant treatment. Overall survival (OS), disease specific survival (DSS), disease free survival (DFS) and local control (LC) were calculated with Kaplan-Meier method. Results: A total of 85 patients were enrolled in this study, the median age was 80 years old (range: 75-90 years). After neoadjuvant treatment, surgery was performed in 56 patients (65.9%). Downstaging rate was 85.7% (48/56) with T downstaging in 35 patients (62.5%) and N downstaging in 36 patients (64.3%). Twelve patients (21.4%) obtained pathological complete response (pCR). The incidence of grade 3 or greater acute hematological, gastrointestinal and genitourinary toxicities were 10.7%, 5.2% and 1.8%, respectively. Seven patients (12.5%) experienced postoperative complications. The median follow-up duration was 35.7 months (range: 4.3-100.3 months), The 3-year and 5-year OS, DSS, DFS, LC were 68.9% and 47.2%, 75.8% and 60.4%, 68.2% and 56.1%, 83.9% and 78.3%, respectively. Conclusion: In patients aged 75 years or older with LARC, neoadjuvant chemoradiotherapy followed by surgery was well tolerated with promising survival outcomes, which should be strongly suggested if medically suitable.
Collapse
Affiliation(s)
- Xiaoliang Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Junjie Wang
- Department of Gynecological Oncology, Qingdao Center Hospital, Qingdao, Shandong, the People's Republic of China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Yi Xiao
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Xin Lian
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Zhikai Liu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Junfang Yan
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| | - Zheng Miao
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, the People's Republic of China
| |
Collapse
|
5
|
De Felice F, Crocetti D, Maiuri V, Parisi M, Marampon F, Izzo L, De Toma G, Musio D, Tombolini V. Locally Advanced Rectal Cancer: Treatment Approach in Elderly Patients. Curr Treat Options Oncol 2020; 21:1. [PMID: 31927649 DOI: 10.1007/s11864-019-0692-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Independently of age, evidence-based guidelines recommend a multidisciplinary treatment approach in patients with locally advanced rectal cancer (LARC). But actually, elderly patients are grossly underrepresented in clinical trials, accounting < 10% of enrolled cases. Therefore, LARC management in elderly patients remains a crucial issue in daily practice, especially due to their frailty. Multiple clinical factors, including general health status, cognitive status, co-morbidity, disability, and life expectancy should be considered to understand the complexities of geriatric assessment and then define therapy. We use a patient-centered approach in order to tailor the optimal treatment strategy. We treat fit elderly patients as younger patients, including neoadjuvant chemoradiotherapy (CRT), surgery, and adjuvant chemotherapy. Whereas, in vulnerable and frail patients, we propose standard CRT (vulnerable patients) or radiotherapy alone (frail patients).
Collapse
Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy.
| | - Daniele Crocetti
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Veronica Maiuri
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
| | - Martina Parisi
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
| | - Francesco Marampon
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
| | - Luciano Izzo
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Giorgio De Toma
- Department of Surgery "Pietro Valdoni", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Viale Regina Elena 326, 00161, Rome, Italy
| |
Collapse
|
6
|
Liu H, Li C, Zhao Z, Guan X, Yang M, Liu Z, Tang Y, Jiang Z, Wang X. Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study. Technol Cancer Res Treat 2020; 19:1533033820970339. [PMID: 33161830 PMCID: PMC7658521 DOI: 10.1177/1533033820970339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/23/2020] [Accepted: 07/09/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. METHOD Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed. RESULTS The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. CONCLUSIONS nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.
Collapse
Affiliation(s)
- Hengchang Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunxiang Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhixun Zhao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zheng Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
7
|
Yavas G, Yavas C. Comment on De Felice et al, "Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes". Clin Colorectal Cancer 2019; 18:e368-e369. [PMID: 31409534 DOI: 10.1016/j.clcc.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/07/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Guler Yavas
- Department of Radiation Oncology, Selcuk University, Konya, Turkey
| | - Cagdas Yavas
- Department of Radiation Oncology, Selcuk University, Konya, Turkey
| |
Collapse
|
8
|
Nishikawa T, Kawai K, Hata K, Emoto S, Murono K, Sasaki K, Tanaka T, Nozawa H, Ishihara S. Clinical outcomes of preoperative chemoradiotherapy in octogenarian with locally advanced rectal cancer. Mol Clin Oncol 2019; 11:181-188. [PMID: 31281654 DOI: 10.3892/mco.2019.1873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
The number of elderly patients who receive surgical treatment for rectal cancer has gradually increased with aging of the population. In recent years, preoperative chemoradiotherapy, followed by surgical treatment, has been widely used for treating patients with locally advanced rectal adenocarcinoma. The aim of the present study was to evaluate if preoperative chemoradiotherapy is efficacious and safe for the treatment of rectal cancer in patients older than 80 years. A total of 293 patients with rectal cancer, who received preoperative chemoradiotherapy from 2007 to 2017, were studied. Comorbidities and the short- and long-term outcomes in elderly patients (aged ≥80 years old) were investigated and compared to younger patients. The elderly group comprised of 17 patients (5.8%). Pulmonary disease was the most common comorbidity (23.5%). No significant difference between the two groups regarding the rate of completeness of chemoradiotherapy was detected (P=0.26). Curative resection was performed in 14 patients in the elderly group and 252 patients in the younger group. Among 7 patients from both groups who could not receive curative resection due to their poor general condition, 4 patients had decreased lower respiratory function due to pneumonia (3 patients) or chronic obstructive pulmonary disease (1 patient). Morbidity and mortality rates were similar in elderly and younger groups (35.7% vs. 27.0%, 0% vs. 0%, respectively; P=0.54, P=1.00). No significant difference was found regarding recurrence between the two groups (P=1.00). To conclude, preoperative chemoradiotherapy in elderly patients with rectal cancer is safe and well tolerated.
Collapse
Affiliation(s)
- Takeshi Nishikawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| |
Collapse
|