Implications for determining the optimal treatment for locally advanced rectal cancer in elderly patients aged 75 years and older

Abstract

// Jue-feng Wan 1 , Ji Zhu 1 , Gui-chao Li 1 , Wen-jie Sun 1 and Zhen Zhang 1 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China Correspondence to: Zhen Zhang, email: // Keywords : rectal cancer, elderly, optimal, SEER Received : April 05, 2015 Accepted : June 11, 2015 Published : June 23, 2015 Abstract Patients were excluded if they were older than 75 years of age in most clinical trials. Thus, the optimal treatment strategies in elderly patients with locally advanced rectal cancer (LARC) are still controversial. We designed our study to specifically evaluate the cancer specific survival of four subgroups of patients according to four different treatment modalities: surgery only, radiation (RT) only, neoadjuvant RT and adjuvant RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. The results showed that the 5-year cancer specific survival (CSS) was 52.1% in surgery only, 27.7% in RT only, 70.4% in neoadjuvant RT and 60.4% in adjuvant RT, which had significant difference in univariate log-rank test ( P < 0.001) and multivariate Cox regression ( P < 0.001). Thus, the neoadjuvant RT and surgery may be the optimal treatment pattern in elderly patients, especially for patients who are medically fit for the operation.