Radiotherapy among nonagenarians with anal or rectal carcinoma: should we avoid or adapt treatment?

Abstract

Dear editor, Radiotherapy is a cornerstone in the management of anal or rectal cancer. Because elderly patients are often excluded from clinical trials, little is known about radiotherapy’s therapeutic index (efficacy/toxicity ratio) in the geriatric population [1]. Still, the ageing of population imposes the challenge to treat older cancer patients and probably to adjust their treatment [2]. A few studies reported data on radiation-induced toxicities in nonagenarian patients, but data on efficacy are still scarce. For rectal cancer, preoperative radiotherapy programs were suggested to be feasible in elderly patients [3–5], with a preference for short protocols without chemotherapy [4]. For anal cancer, the safety of radiochemotherapy was only reported in limited sets of elderly patients [6]. The objective of the present study was to report efficacy and toxicity data on the radiotherapy treatment of nonagenarian patients with anal or rectal cancer. We analyzed the data of 34 nonagenarian patients with anal or rectal cancers: 27 (79.4%) with a rectal adenocarcinoma and 7 (20.6%) with an anal canal squamous cell carcinoma. At the time of irradiation treatment, the patients’ mean age was 92.7 years (standard deviation, 2.3 years). Before radiotherapy, 19 patients (55.9%) had an Eastern Cooperative Oncology Group Performance Status score of two or higher. Eleven patients (32.4%) were nursing home residents. Primarily, 16 patients (47.1%) were diagnosed with a locally advanced tumor (T3-4 or N1-3) and 6 (17.6%) with a metastatic disease. Seven patients (20.6%) underwent surgery before radiotherapy. Patient characteristics are shown in Table 1.