Is Chemotherapy or Radiation Therapy in Addition to Surgery Beneficial for Locally Advanced Rectal Cancer in the Elderly? A National Cancer Data Base (NCDB) Study

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2015 Nov 15

PMID 26566779

Citations 7

Authors

J R Bergquist

C A Thiels

C R Shubert

E B Habermann

A V Hayman

M D Zielinski

K L Mathis

Affiliations

Soon will be listed here.

Abstract

Introduction: Current National Comprehensive Cancer Network guidelines for Stages II and III rectal cancer recommend neoadjuvant chemoradiation followed by curative intent surgery and adjuvant chemotherapy. It is unclear whether therapies in addition to surgery are truly beneficial in elderly patients. Our aim was to compare the survival of patients over 80 with Stages II and III rectal cancer undergoing curative intent surgery with or without additional therapy.

Materials And Methods: The National Cancer Data Base (NCDB 2006-2011) was queried for patients over 80 with Stages II and III rectal cancer. The primary outcome was overall survival. Patients were stratified based upon therapy group. Univariate group comparisons were made. Unadjusted Kaplan-Meier and multivariable Cox proportional hazards modeling survival analyses were performed.

Results: The query yielded 3098 patients over 80 with Stage II (N = 1566) or Stage III (N = 1532) disease. Approximately, half of the patients received surgery only. Kaplan-Meier analysis showed improved survival for patients receiving neoadjuvant and/or adjuvant therapy in addition to surgery, but there was no significant difference between those that received guideline concordant care (GCC), neoadjuvant chemoradiation only, or post-operative chemotherapy only. Cox proportional hazard modeling identified age >90 and margin positivity as independent risk factors for decreased overall survival.

Conclusion: Analysis of NCDB data for Stages II and III rectal cancer in patients over 80 shows a survival benefit of adjuvant and/or neoadjuvant therapy over surgery alone. There does not appear to be a difference in survival between patients who received neoadjuvant chemoradiation, post-resection adjuvant chemotherapy, or GCC.

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References

Germer C, Isbert C . [Quality of life after rectal cancer surgery]. Chirurg. 2009; 80(4):316-23. DOI: 10.1007/s00104-008-1623-6. View

Shahir M, Lemmens V, van de Poll-Franse L, Voogd A, Martijn H, Janssen-Heijnen M . Elderly patients with rectal cancer have a higher risk of treatment-related complications and a poorer prognosis than younger patients: a population-based study. Eur J Cancer. 2006; 42(17):3015-21. DOI: 10.1016/j.ejca.2005.10.032. View

Raval M, Bilimoria K, Stewart A, Bentrem D, Ko C . Using the NCDB for cancer care improvement: an introduction to available quality assessment tools. J Surg Oncol. 2009; 99(8):488-90. DOI: 10.1002/jso.21173. View

Camilleri-Brennan J, Steele R . The impact of recurrent rectal cancer on quality of life. Eur J Surg Oncol. 2001; 27(4):349-53. DOI: 10.1053/ejso.2001.1115. View

Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D . Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003; 238(2):203-13. PMC: 1422675. DOI: 10.1097/01.sla.0000080823.38569.b0. View

Wedding U, Rohrig B, Klippstein A, Brix C, Pientka L, Hoffken K . Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients. Support Care Cancer. 2007; 15(9):1097-104. DOI: 10.1007/s00520-007-0228-9. View

Schrag D, Cramer L, Bach P, Begg C . Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst. 2001; 93(11):850-7. DOI: 10.1093/jnci/93.11.850. View

Bosset J, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L . Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006; 355(11):1114-23. DOI: 10.1056/NEJMoa060829. View

McGinnis L . Surgical treatment options for colorectal cancer. Cancer. 1994; 74(7 Suppl):2147-50. DOI: 10.1002/1097-0142(19941001)74:7+<2147::aid-cncr2820741723>3.0.co;2-e. View

10.

Abir F, Alva S, Longo W . The management of rectal cancer in the elderly. Surg Oncol. 2004; 13(4):223-34. DOI: 10.1016/j.suronc.2004.08.008. View

11.

Barisic G, Markovic V, Popovic M, Dimitrijevic I, Gavrilovic P, Krivokapic Z . Function after intersphincteric resection for low rectal cancer and its influence on quality of life. Colorectal Dis. 2010; 13(6):638-43. DOI: 10.1111/j.1463-1318.2010.02244.x. View

12.

Vironen J, Kairaluoma M, Aalto A, Kellokumpu I . Impact of functional results on quality of life after rectal cancer surgery. Dis Colon Rectum. 2006; 49(5):568-78. DOI: 10.1007/s10350-006-0513-6. View

13.

Manceau G, Karoui M, Werner A, Mortensen N, Hannoun L . Comparative outcomes of rectal cancer surgery between elderly and non-elderly patients: a systematic review. Lancet Oncol. 2012; 13(12):e525-36. DOI: 10.1016/S1470-2045(12)70378-9. View

14.

Harrison J, Solomon M, Young J, Meagher A, Butow P, Salkeld G . Patient and physician preferences for surgical and adjuvant treatment options for rectal cancer. Arch Surg. 2008; 143(4):389-94. DOI: 10.1001/archsurg.143.4.389. View

15.

Finlayson E, Fan Z, Birkmeyer J . Outcomes in octogenarians undergoing high-risk cancer operation: a national study. J Am Coll Surg. 2007; 205(6):729-34. DOI: 10.1016/j.jamcollsurg.2007.06.307. View

16.

Benson 3rd A, Bekaii-Saab T, Chan E, Chen Y, Choti M, Cooper H . Rectal cancer. J Natl Compr Canc Netw. 2012; 10(12):1528-64. DOI: 10.6004/jnccn.2012.0158. View

17.

Abraham A, Habermann E, Rothenberger D, Kwaan M, Weinberg A, Parsons H . Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines. Cancer. 2012; 119(2):395-403. DOI: 10.1002/cncr.27755. View

18.

Gerstenhaber F, Grossman J, Lubezky N, Itzkowitz E, Nachmany I, Sever R . Pancreaticoduodenectomy in elderly adults: is it justified in terms of mortality, long-term morbidity, and quality of life?. J Am Geriatr Soc. 2013; 61(8):1351-7. DOI: 10.1111/jgs.12360. View

19.

Chang G, Skibber J, Feig B, Rodriguez-Bigas M . Are we undertreating rectal cancer in the elderly? An epidemiologic study. Ann Surg. 2007; 246(2):215-21. PMC: 1933551. DOI: 10.1097/SLA.0b013e318070838f. View

20.

Kerr S, Norton S, Glynne-Jones R . Delaying surgery after neoadjuvant chemoradiotherapy for rectal cancer may reduce postoperative morbidity without compromising prognosis. Br J Surg. 2008; 95(12):1534-40. DOI: 10.1002/bjs.6377. View