Safety and Long-Term Effect Assessment of Neoadjuvant Chemoradiotherapy for Elderly Patients With Locally Advanced Rectal Cancer: A CHN Single-Center Retrospective Study

Abstract

Introduction: Neoadjuvant chemoradiotherapy (nCRT) followed by operation has become the standard treatment for locally advanced rectal cancer (LARC). However, considering the possible toxicity and complications of radiochemotherapy, nCRT is seldom used for the elderly. The purpose of this study was to assess the safety and long-term effect of nCRT combined with TME in elderly patients with LARC. Method: Four-hundred-fourteen LARC patients were divided into 2 groups: 108 patients were in the elderly group (≥ 65 years old) and 306 patients were in the non-elderly group (<65 years old). The side effects, toxicity, complications, disease-free survival (DFS), and overall survival (OS) of all of the patients were assessed. Results: The data comprised 103 patients in the elderly group and 292 patients in the non-elderly group who completed nCRT sessions following operation. The treatment-completion rates of the elderly and non-elderly groups were 95.37% and 95.42%, respectively. Twenty-two patients developed radiotherapy complications (grade III) in the elderly group and 37 such cases developed in the non-elderly group. Diarrhea, skinulcer, and perianal pain were ranked as the top 3 most common complications. The incidence of infection, anastomotic leakage, and intestinal obstruction was 0.97% in the elderly group. The 5-year DFS and 5-year OS rate were 70.7% and 80.8% in the elderly group, 67.3% and 81.6% in the non-elderly group respectively. Conclusions: nCRT are safe and effective for elderly patients, and it does not increase the risk of postoperative complications for the elderly. Hence, nCRT should not be withheld based on age alone.