Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer
Menée à partir de données portant sur 1 172 patients atteints d'un cancer rectal de stade localement avancé traité par chirurgie entre 2005 et 2012, cette étude évalue, du point de vue de la survie sans maladie, de la survie spécifique et de la survie globale, l'efficacité d'une chimioradiothérapie néoadjuvante en fonction de l'âge des patients (moins de 70 ans, 70 ans ou plus)
Background : Studies of clinical outcomes of elderly patients treated with neoadjuvant chemoradiation (nCRT) for locally advanced rectal cancer (LARC) are limited. Our aim was to assess the impact of age on clinical outcomes in a large multi-institutional database. Patients and Methods : Data for patients diagnosed with LARC who received nCRT and curative intent surgery between 2005 and 2012 were collected from five major Canadian Cancer Centres. Age was analyzed as a continuous and dichotomous variable (<70 v≥70 years) and correlated with disease free survival (DFS), cancer specific survival (CSS) and overall survival (OS). Cox regression models were used to adjust for important prognostic factors. Results : Of 1,172 patients included, 295 (25%) were ≥70 years, and they were less likely to receive adjuvant chemotherapy (ACT) (60% v 79%, p<0.0001), oxaliplatin-based ACT (12% v 31%, p<0.0001), less likely to complete nCT (76% v 86%, p<0.001), and more likely to be anemic at initiation of nCRT (42% v 30%, p= 0.0004). In MVA, age >70 years was associated with similar DFS (HR 0.93, 95% CI 0.68 – 1.26, p=0.63), similar CSS (HR 0.81, 95% CI 0.46 – 1.41, p=0.45) and similar OS (HR 1.28, 95% CI 0.88 – 1.86, p=0.20) compared to the younger age group. As a continuous variable, increasing age was not predictive of DFS (HR 1.00, 95% CI 0.99 – 1.02, p=0.49) or CSS (HR 1.002, 95% CI 0.98 – 1.02, p=0.88), however, it correlated with an inferior OS (HR 1.02, 95% CI 1.00 – 1.03, p=0.04). Conclusions : Elderly patients (≥70 years) who receive nCRT followed by surgery appear to have similar outcomes compared to younger patients. Decisions regarding eligibility for nCRT and surgery should not be based on age alone.