Radiation Therapy In Elderly Rectal Cancer Patients

Background and Purpose1) To investigate the efficacy, prognosis and potential risk factors for elderly rectal cancer patients who received radiation therapy.2) To analyze treatment toxicities and tolerence in elderly rectal cancer patient with pelvic radiation.3) To provide baseline parameters of elderly rectal cancer patients treated with radiation+-chemotherapy for further randomized trial in this group of patients.MethodsWe reviewed129cases of rectal cancer patients who received radiation therapy in Department of radiation therapy at Shanghai cancer center of Fudan University. All patients were>=70years. Parameters we analyzed including:gender, age, co-morbidities, tumor charicteristics, treatment received pathological findings and treatmet induced toxicities. Kaplan-Meier were used to analyzed OS and DFS. χ2tests were applied evaluate toxicities. Multivariate analysis was used to find independent prognositic of clinical outcome.ResultThere were126patients (97.7%) who completed whole course of radiation therapy as planed. The2,3-years OS:were72.2%and59%respectively.2,3years OS:100%, and66.7%in neo-adjuvant chemo-radiation therapy group.2,3years OS:88.2%and83%, and2,3years DFS:85.3%and75.8%in adjuvant chemo-radiation therapy group.2,3years OS:48%and16%in esclusive radiation therapy group for non-metastases patients.2-years OS:58.9%in patients who suffered local recurrence of rectal cancer with no metastases.2,3years OS:45.7%and22.8%in stage IV patients received esclusive radiation therapy for rectal lesion.Our analysis results showed that age (P=0.0025), AJCC staging (P=0.0057), purpose of the radiation therapy (P=0.001) were the significant unitivarate factors of OS. Multivariate analysis showed that only age (P=0.001) and purpose of the radiation therapy (P=0.047) were the independent prognostic factor of OS. N stage (P=0.0151) was the unitivarate factors of OS and DFS in adjuvant chemo-radiation therapy group. There was no grade IV acute toxicity observed. More Grade III toxicity was observed in the group of patients received concurrent-chemotherapy (P=0.002).Conclusion1The2-,3-years overall survival of the whole group with age>70are72%and59%respectively.Age was the significant unitivarate factors of OS and independent prognostic factor of OS in this group of>70years old rectal cancer patients.Patients over75had poor prognosis.2Stage was the significant unitivarate factors of OS but not the independent prognostic factor of OS in this group of≥70years old rectal cancer patients. N stage was the unitivarate factors of OS and DFS in adjuvant chemo-radiation therapy group. NO had favourable prognosis, while N2showed poor prognosis,and N1was in the middle.3Different purpose of the radiation therapy were the significant unitivarate factor and independent prognostic factor of OS in elderly patients. Neo-adjuvant and adjuvant radiation therapy group had the similar prognosis as younger patients.4Hypertension and diabetes were the most common co-morbidities in elderly patients. but we didn’t find them associate to OS. There were no influence from co-morbidities to prognosis had been obersved.5The rectal cancer patients≥70showed well tolorent to radiation or chemo-radiation. Concurrent chemotherapy possibly incrsased Grade Ⅲ toxicity in these rectal cancer patients≥70.