P-322 - Concomitent radiochemotherapy in elderly patients with locally-advanced rectal cancer

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Anti-Cancer Agents & Biologic Therapy
Geriatric Oncology
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter R. Anghel
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors R. Anghel1, R. Mitrica1, L. Gales1, C. Nitipir2, O. Trifanescu1, I. Popescu3
  • 1Institute of Oncology “Al. Trestioreanu” Bucharest, Bucharest/RO
  • 2Carol Davila University of Medicine and Pharmacy, Bucharest/RO
  • 3Fundeni Clinical Institute, Bucharest/RO

Abstract

Introduction

The number of elders affected by rectal cancer is high and will continue to grow because life expectancy is constantly increasing. Preoperative chemoradiotherapy tends to became the new standard treatment for locally advanced rectal cancer, with better local control and minimal or no survival advantages. We conducted a prospective single arm study to evaluate the efficacy of preoperative capecitabine based chemoradiotherapy in elderly patients with rectal cancer. The primary objectives of our study were evaluation of the efficacy of the treatment regarding response rate and sphincter preservation rate and the safety profile. The secondary objectives were progression free survival and overall survival rates at 2 year.

Methods

Seventy two selected patients over 65 years with stage II or stage III confirmed rectal adenocarcinoma were treated between 2001 and 2010. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Frail patients according to CGA (category III) were excluded. The treatment schedule consisted in concomitant radio-chemotherapy. At the end of chemoradiation the patients were evaluated for surgery. The fit patients underwent surgery and the others received definitive radiation. None of the patients received adjuvant therapy. All patients received external beam radiation therapy up to a total dose of 50-54 Gy, in daily 180-200 cGy fractions, 5 days/week, using 4 fields technique. In 31 cases external radiotherapy was followed by endocavitary HDR brachytherapy with a total dose of 10 Gy on the tumor volume, 500 cGy/fraction– 2 fractions, 1 fraction/week. Chemotherapy schedule was based on Capecitabine 825mg/m2 twice daily, at 30 min after the meals, 7 days per week.

Results

All patients were evaluable for safety profile. Gastrointestinal toxicities were diarrhea that occurred in 63 patients (87.5%) with grade 3 - 4 only in 10 patients (13.8%); vomiting and nausea 47 patients (65.3%) with grade 3 – 4 in 5 patients (6.9%). Hematological toxicity occurred in 23 patients (31.9%), but grade 3-4 in 6 patients (8.3%). Hand-foot syndrome was present in 2 patients (2.77%). The other primary objective was to identify the response rate in our series. Overall response rate was 76.3%, with complete response obtained in 4 patients (5.6%), partial response in 51 patients (70.8%). Eight patients (11.1%) were evaluated with stable disease. Progressive disease was found in 9 patients (12.5%). In 16 cases (22.2%) sphincter preservation surgery was performed and in 4 cases (5.6%) complete pathological response was obtained. Progression free survival was 48.6% (35/72), local relapse (LR) was 20.8% (15/72), and distant recurrence rate was 11.1% (8/72) at 2 years. Mortality was 19.5% (14 patients) at 2 years. There were 9 cancer related deaths (12.5%), and 5 deaths (6.9%) due to comorbidities.

Conclusion

Concomitant preoperative chemoradiation in locally advanced rectal cancer could be an option for the treatment of elderly patients as in younger ones. Our data offer comparable results with published clinical trials which did not include age-selected patients.