Chronological age does not predict poor outcomes after neoadjuvant chemoradiotherapy for rectal cancer: a...

The benefit of neoadjuvant chemoradiotherapy (NACRT) for elderly patients with locally advanced rectal cancer (LARC) remains unclear because these patients are often excluded from trials. We evaluated the safety and oncologic outcomes of NACRT in elderly LARC patients.

The subjects of this retrospective analysis were 98 LARC patients who underwent radical resection after NACRT. We compared patients aged ≥ 75 years (Elderly group) with non-elderly patients (non-Elderly group), assessing treatment completion, adverse events, pathological response, and survival outcomes. Prognostic factors for relapse-free survival (RFS) were examined using Cox regression.

The Elderly group patients had poorer performance status and more frequent chemotherapy dose reductions. The median relative dose intensity of chemotherapy did not differ significantly between the Elderly and non-Elderly groups, and the median relative dose intensity of radiotherapy was 100% in both groups. The incidence of grade ≥ 3 adverse events was comparable between the groups. RFS (P = 0.313) and cancer-specific survival (P = 0.408) did not differ significantly. Multivariate analysis identified the American Society of Anesthesiologists-performance status score 3 (HR: 4.64, P = 0.002), Clavien-Dindo grade ≥ 3 complications (HR: 2.72, P = 0.008), and ypN3 (HR: 2.96, P = 0.036), but not age, as independent predictors of RFS.

Chronological age did not affect toxicity, pathological response, or survival outcomes adversely. Thus, NACRT can be offered safely to elderly LARC patients with appropriate performance status, suggesting that age alone should not preclude curative treatment.