Management of Colorectal Cancer (CRC) in the Elderly: Experience of Oncology Department of Ariana, Tunisia

Abstract

Background: Old patients with CRC are underrepresented within oncology clinical trials. The net effect of lack of clinical trial data is a delayed understanding of the optimal management of CRC among the elderly as compared to younger patients. Although, the incidence is increasing with advancing age, doubling every seven years for patients age 50 years and over. The objective of this study is to make a focus on epidemiological, clinical, therapy and prognosis features of this disease in Tunisia. Methods: A retrospective study was conducted on concerned patients aged of 65 years or greater with histologically confirmed CRC treated at the department of medical oncology of Abderrahmane Mami hospital during 5 years (2008-2012). We analyzed their epidemiological, anatomo-clinical features, treatment and therapeutic results. Results: 139 patients ( pts) were studied. Median age was 73 years (65-88 years). Sex-ratio was 1.83. Twenty pts (14.4%) had a family history of cancer (colon in 9 cases). Median time to diagnosis was 6 months (1-36 months). Pts consulted mostly for abdominal pain (17.3%) and constipation (11.5%). The performance status was 1-2 in 60%. Tumor was colic in 85.6% and rectal in the remaining cases. Tumor stage was II, III and IV in 22.3, 45.3 and 32.4% of cases respectively. Metastases were hepatic in 95.5%, peritoneal in 15.55% and pulmonary in 13.33% of cases. Adjuvant chemotherapy (CT) was administered in 53.95% of pts. Palliative CT was done in 45.3% of cases. Neoadjuvant radiotherapy with or without CT were administered in 11 pts having rectal cancer. The most commonly used CT was FOLFOX (75% for adjuvant treatment, 76.8% for first line and 37.5% for second line treatment). Improvement of the quality of life with CT was obtained in 66.96% of pts. CT was well tolerated in 38.39% of pts. The most common toxicities were neuropathy of grade 1-2 (25.9%) and vomiting (23.21%). Progression after palliative CT occurred in 31.74% of pts. Recurrence occurred in 26 pts (18.7%) after a median follow up of 15 months (1-120 months). Recurrence was hepatic in most cases (12 pts). Only local recurrence was observed in 5 pts. Death occurred in 75.53% of pts. Median overall survival (OS) was 12 months (2-120 months). OS at 3 years was 21.8%. Median event free survival (EFS) was 9 months (2-120 months). EFS at 2 years were 25.2%. Conclusion: Elderly pts with good performance status tolerated adjuvant and palliative CT for CRC as well as younger patients. Age alone should not be a deterrent to the use of CT.