Colorectal cancer (CRC) is one of the most common malignancies and most often occurs in patients (pts) aged 65 years or older. As our population ages, elderly cancer care has become a growing challenge. However octogenarian pts are understaged, undertreated and underrepresented in scientific literature. The purpose of this study was identify data of our population over 80 years
We performed an institutional retrospective observational cohort study of pts with CRC referred to Medical Oncology during 4 years (2012–2015), and followed until April 2016. The inclusion criteria were age >80 years old and pathologic-confirmed CRC
112 pts were included in this study. Octogenarian were a 16% of all CRC pts. The median age was 84 years (range 79–94), 55% male (n = 61). The tumor was located in the rectum, left and right colon in 19%, 37% and 44% of cases. The majority (72%) were diagnosed in stage III-IV and 28% patients in stages I-II. One metastatic site was found in 69% pts, 2 sites in 21% and 10% had 3 or more; the main metastatic site was liver (56%) 44 (38%) pts underwent surgery (ST) and chemotherapy (CT) (4 pts in the neo-adjuvant setting); 22 (20%) pts only CT and 13 (12%) pts benefited from best supportive care (BSC) As first-line therapy: 70% received capecitabine (cape) monotherapy (25 in Stage III and 20 in IV), 18% oral tegafur-uracil (UFT), 8% capeox (cape and oxaliplatin) and only one patient capeox-bevacizumab. 19%(21) of pts had second-line treatment (8 cape, 6 capeox, 5 cape-irinotecan and 2 UFT); 2 pts had 3 lines. 53 (47%) pts died and most at hospital (60%). Median follow-up was 19 months (mo). Median OS was 30.6 mo (95%CI 26-35) Stage IV pts had an expected survival of 14 mo, stage III 34 mo and stage I-II pts 44 mo with statistically significant difference. Survival is 35 mo for ST and CT group and in BSC was 16 mo (p 0.001) According to first-line therapy, cape monotherapy vs capeox, median survival was 24 and 41 mo respectively (95%CI 17–30 and 35-46) with no statistically significant difference (p 0.42)
In the present study, conventional CT had significant benefit for OS in very elderly pts with CRC. The most significant factors for OS were stage at diagnosis and treatment. Further studies are needed to determine the appropriate treatment in octogenarian pts with CRC.
Clinical trial identification
Legal entity responsible for the study
Elizabeth Inga Saavedra
Complejo Hospitalario Universitario de Badajoz
All authors have declared no conflicts of interest.