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

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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.

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Most cited references 25

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Cancer statistics in China, 2015.

Wanqing Chen, Rongshou Zheng, Peter D Baade … (2016)

With increasing incidence and mortality, cancer is the leading cause of death in China and is a major public health problem. Because of China's massive population (1.37 billion), previous national incidence and mortality estimates have been limited to small samples of the population using data from the 1990s or based on a specific year. With high-quality data from an additional number of population-based registries now available through the National Central Cancer Registry of China, the authors analyzed data from 72 local, population-based cancer registries (2009-2011), representing 6.5% of the population, to estimate the number of new cases and cancer deaths for 2015. Data from 22 registries were used for trend analyses (2000-2011). The results indicated that an estimated 4292,000 new cancer cases and 2814,000 cancer deaths would occur in China in 2015, with lung cancer being the most common incident cancer and the leading cause of cancer death. Stomach, esophageal, and liver cancers were also commonly diagnosed and were identified as leading causes of cancer death. Residents of rural areas had significantly higher age-standardized (Segi population) incidence and mortality rates for all cancers combined than urban residents (213.6 per 100,000 vs 191.5 per 100,000 for incidence; 149.0 per 100,000 vs 109.5 per 100,000 for mortality, respectively). For all cancers combined, the incidence rates were stable during 2000 through 2011 for males (+0.2% per year; P = .1), whereas they increased significantly (+2.2% per year; P < .05) among females. In contrast, the mortality rates since 2006 have decreased significantly for both males (-1.4% per year; P < .05) and females (-1.1% per year; P < .05). Many of the estimated cancer cases and deaths can be prevented through reducing the prevalence of risk factors, while increasing the effectiveness of clinical care delivery, particularly for those living in rural areas and in disadvantaged populations.

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Cancer Statistics, 2017.

Rebecca L Siegel, Kimberly D Miller, Ahmedin Jemal (2017)

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the "epidemic of diagnosis." Over the past decade of available data, the overall cancer incidence rate (2004-2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7-30. © 2017 American Cancer Society.

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Colorectal cancer statistics, 2017.

Rebecca L Siegel, Kimberly D Miller, Stacey A Fedewa … (2017)

Colorectal cancer (CRC) is one of the most common malignancies in the United States. Every 3 years, the American Cancer Society provides an update of CRC incidence, survival, and mortality rates and trends. Incidence data through 2013 were provided by the Surveillance, Epidemiology, and End Results program, the National Program of Cancer Registries, and the North American Association of Central Cancer Registries. Mortality data through 2014 were provided by the National Center for Health Statistics. CRC incidence rates are highest in Alaska Natives and blacks and lowest in Asian/Pacific Islanders, and they are 30% to 40% higher in men than in women. Recent temporal patterns are generally similar by race and sex, but differ by age. Between 2000 and 2013, incidence rates in adults aged ≥50 years declined by 32%, with the drop largest for distal tumors in people aged ≥65 years (incidence rate ratio [IRR], 0.50; 95% confidence interval [95% CI], 0.48-0.52) and smallest for rectal tumors in ages 50 to 64 years (male IRR, 0.91; 95% CI, 0.85-0.96; female IRR, 1.00; 95% CI, 0.93-1.08). Overall CRC incidence in individuals ages ≥50 years declined from 2009 to 2013 in every state except Arkansas, with the decrease exceeding 5% annually in 7 states; however, rectal tumor incidence in those ages 50 to 64 years was stable in most states. Among adults aged <50 years, CRC incidence rates increased by 22% from 2000 to 2013, driven solely by tumors in the distal colon (IRR, 1.24; 95% CI, 1.13-1.35) and rectum (IRR, 1.22; 95% CI, 1.13-1.31). Similar to incidence patterns, CRC death rates decreased by 34% among individuals aged ≥50 years during 2000 through 2014, but increased by 13% in those aged <50 years. Progress against CRC can be accelerated by increasing initiation of screening at age 50 years (average risk) or earlier (eg, family history of CRC/advanced adenomas) and eliminating disparities in high-quality treatment. In addition, research is needed to elucidate causes for increasing CRC in young adults. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:177-193. © 2017 American Cancer Society.

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Author and article information

Journal

Journal ID (nlm-ta): Technol Cancer Res Treat

Journal ID (iso-abbrev): Technol Cancer Res Treat

Journal ID (publisher-id): TCT

Journal ID (hwp): sptct

Title: Technology in Cancer Research & Treatment

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Print): 1533-0346

ISSN (Electronic): 1533-0338

Publication date (Electronic): 9 November 2020

Publication date Collection: 2020

Volume: 19

Electronic Location Identifier: 1533033820970339

Affiliations

[1 ]Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

[2 ]Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

[3 ]Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Author notes

[*]Zheng Jiang, and Xishan Wang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China. Emails: jiangzheng@ 123456cicams.ac.cn ; wangxishan@ 123456cicams.ac.cn

Author information

Hengchang Liu https://orcid.org/0000-0001-8716-5585

Zheng Jiang https://orcid.org/0000-0002-1369-3681

Article

Publisher ID: 10.1177_1533033820970339

DOI: 10.1177/1533033820970339

PMC ID: 7658521

PubMed ID: 33161830

SO-VID: 6a9ec659-c57e-49ae-bfe7-767b83c31d23

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 29 December 2019

Date revision received : 23 June 2020

Date accepted : 09 July 2020

Funding

Funded by: Beijing Hope Run Special Fund from Cancer Foundation of China, https://doi.org/10.13039/501100001809;

Award ID: LC2017A19

Custom metadata

cover-date January-December 2020

typesetter ts3

Keywords: rectal cancer,neoadjuvant chemoradiotherapy,elderly,safety,survival

Data availability:

Keywords: rectal cancer, neoadjuvant chemoradiotherapy, elderly, safety, survival

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

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Abstract

Introduction:

Method:

Results:

Conclusions:

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Security and Safety (S&S)

Most cited references 25

Cancer statistics in China, 2015.

Cancer Statistics, 2017.

Colorectal cancer statistics, 2017.

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