P-317 - Outcome of elderly patients with non-metastatic rectal cancer: a retrospective study

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Geriatric Oncology
Rectal Cancer
Presenter M.-A. Bureau
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors M.-. Bureau, A. Beaudoin, F. Lemay, R.-. Beauchamp, B. Chouikh
  • Université de Sherbrooke, Sherbrooke/CA

Abstract

Introduction

Neoadjuvant chemoradiotherapy has a proven benefit in non-metastatic locally advanced rectal adenocarcinoma and adjuvant therapy is than often offered to patients. However, the benefits behind these treatments are not as clear for elderly patients (>75 years old) who are frequently frail and more likely to suffer complications. We conducted this study in our population to determine the outcome of patients who have had surgery for non-metastatic rectal adenocarcinoma with a particular focus on the elderly population.

Methods

All patients who underwent surgery for non-metastatic rectal adenocarcinoma at the Centre Hospitalier Universitaire de Sherbrooke between 2000 and 2010 were included in this study. Patients who had concomitant neoplasia were excluded. Information about patient's comorbidities, tumour location and histology, staging and treatments (neoadjuvant and adjuvant) were retrospectively analyzed. Overall survival (OS) and disease free survival (DFS) were compared using Kaplan-Meier plots. Multivariate analysis was done with a Cox regression model.

Results

A total of 319 patients were included and 86 were 75 years or older (27,0% from 75 to 89 years old). Five-year OS for all patients was 82% whilst five-year DFS for all patients was 75,5%. For people 75 years or older, the five-year OS was 66,8% and the five-year DFS was 69,2%. Comparing patients under and over 75 years old, five-year OS was better in younger patients (p < 0,001). However, the difference was not statistically significant at 3 years, and this worst outcome in elderly patients could be related to their reduced life expectancy. Five-year DFS was not significantly different in the two groups. Neoadjuvant chemoradiotherapy, when compared to no neoadjuvant treatment, was associated with a better OS (p = 0,044) particularly in patients with advanced tumors (T3 or T4 or N+). Older patients receiving neoadjuvant treatment had a similar outcome when compared to the younger ones. Adjuvant chemotherapy after neoadjuvant chemoradiotherapy and surgery was associated with a better DFS (p = 0,032). Once again, older patients receiving this treatment did not seem to present a significantly different outcome than their younger counterparts. Finally, we found that there was a statistically significant difference in the chosen treatments for people younger and older than 75 years old. Older patients tended to have less neoadjuvant chemoradiotherapy (22,1% VS 42,1% in younger people), less invasive surgeries like endoanal excision (8,9% VS 3,1% in younger people) and less adjuvant chemotherapy (26,3% VS 63,3% in younger people).

Conclusion

Our study showed that the short-term prognosis (3 years) was similar when comparing patients over and under 75 years old. The difference in five-year OS between these two groups seemed to be more related to their different life expectancies. Elderly patients had a similar outcome when receiving neoadjuvant chemoradiotherapy or adjuvant chemotherapy. However, older patients (>75 y) were more likely to receive less intensive treatment.

Figure: P-317