Results of radical treatment of locally advanced rectal cancer in geriatric and non-geriatric patients

Abstract

Background: It is estimated that 60% of new rectal cancer cases will be diagnosed in patients ≥ 65 years old. The geriatric patient is heterogeneous and underrepresented in clinical trials, and oncologic therapies are often tailored with little evidence. We describe a cohort of patients diagnosed with locally advanced rectal cancer in geriatric and non-geriatric patients.

Materials and methods: Retrospective and descriptive analysis of 137 patients, 44 (32.1%) ≥ 75 years old and 93 (67.9%) ≤ 75 years old, with diagnosis of locally advanced rectal cancer. All patients received neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy.

Results: Mean age was 79.5 for ≥ 75 years and 62.7 for ≤ 75 years, tumor location was: upper rectum (16.1% and 11.3%), middle rectum (60.2% and 47.7%) and lower rectum (23.7% and 41%), using the Eastern Cooperative Oncology Group (ECOG) 0: 74.1% and 81.8%, ECOG 1: 25.9% and 18.2%. Pathological complete response was 21.5% and 22.7%, partial response, 57% and 59% and no response, 21.5% and 18.3%, respectively. Tumor shrinkage in both groups after neoadjuvant treatment was 34.5% and 35.46%. Local recurrence was 2.2% and 3.2% and distance recurrence, 11.3% and 8.6%, respectively.

Conclusion: The study shows similar outcomes in both groups following radical treatment, with similar rates of pathological complete response. However, it has notable limitations, including a small sample size and the absence of a comprehensive geriatric assessment. To enhance these findings, future research should involve larger patient cohorts with comparative analysis and clinical trials specifically focused on the geriatric population.