Tolerability Of Neo-Adjuvant Chemoradiotherapy (Ncrt) With Capecitabine And Surgical Outcomes In Patients Aged 70 Years Or Older With Locally Advanced Rectal Cancer (Larc).

e14600 Background: In studies on colorectal cancer, elderly are frequently underrepresented since comorbid conditions and functional status often lead to study exclusion. In older patients with an indication for nCRT based on T/N stage, physicians decide on clinical grounds whether nCRT should be offered. Aim: to assess the proportion of patients aged ≥ 70 years with (LARC) undergoing nCRT, and to evaluate safety and efficacy of nCRT and subsequent surgery in a selected group of elderly. Methods: We used data from the Dutch Comprehensive Cancer Centre (IKNL) on 1704 rectal cancer patients in 4 Dutch hospitals over the last 10 years. Patient characteristics included clinical TNM stage, pathological staging, preoperative, surgical, adjuvant and palliative treatment and vital statistics. Patients aged ≥ 70 years were included if treated with nCRT according to the ESMO Guidelines, introduced in 2006, and analyzed for treatment deviations, postoperative morbidity, mortality and survival. Data were stratified for patient age into 3 groups: 70-74, 75-79, ≥ 80 years. Results: Between 2006 and 2012 a total of 447 rectal cancer patients aged ≥ 70 were identified. Of these, 42 patients (9%), median age 74 (IQR 72-78), with LARC were treated with nCRT. Overall, 37 patients (88%) completed the planned nCRT. Radiation dermatitis, fatigue and diarrhea was reported in resp. 62%, 57% and 43%. Forty patients (95%) were treated with surgery; 1 patient refused a resection, 1 patient died because of severe mucositis due to DPD-deficiency during nCRT. Postoperative complications were observed in 11 patients (28%) and the 30-day mortality rate was 0%. Two- and five year overall survival rates were 82% (95% CI 70-94) and 49% (95% CI 23-75). Treatment deviations, postoperative morbidity and treatment efficacy were not different in the 3 age groups. Conclusions: This multicenter study shows that only a minority of older patients with LARC are treated with nCRT. However, if selected on clinical grounds, nCRT is safe, well tolerated and leads to a favorable surgical outcome even in older age groups. The results show that elderly should not be excluded from nCRT based exclusively on age.