Outcomes with multimodal therapy for elderly patients with rectal cancer
Background Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 7...
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| Veröffentlicht in: | British journal of surgery 2016-01, Vol.103 (2), p.e106-e114 |
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| creator | Thiels, C. A. Bergquist, J. R. Meyers, A. J. Johnson, C. L. Behm, K. T. Hayman, A. V. Habermann, E. B. Larson, D. W. Mathis, K. L. |
| description | Background
Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older).
Methods
This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan–Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival.
Results
A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60‐month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98).
Conclusion
A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.
Treatment should not be determined by age alone |
| doi_str_mv | 10.1002/bjs.10057 |
| format | Article |
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Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older).
Methods
This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan–Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival.
Results
A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60‐month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98).
Conclusion
A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.
Treatment should not be determined by age alone</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.10057</identifier><identifier>PMID: 26662377</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Aged ; Aged, 80 and over ; Combined Modality Therapy - methods ; Epidemiologic Methods ; Female ; Humans ; Male ; Neoplasm Staging - statistics & numerical data ; Rectal Neoplasms - mortality ; Rectal Neoplasms - therapy ; Retrospective Studies ; Treatment Outcome</subject><ispartof>British journal of surgery, 2016-01, Vol.103 (2), p.e106-e114</ispartof><rights>2015 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2015 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2016 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4627-2bd411eeaf877c80bcd1c005ed14ccb559dc91c244bb8fe8e9e555244f8df15a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.10057$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.10057$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27928,27929,45578,45579</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26662377$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thiels, C. A.</creatorcontrib><creatorcontrib>Bergquist, J. R.</creatorcontrib><creatorcontrib>Meyers, A. J.</creatorcontrib><creatorcontrib>Johnson, C. L.</creatorcontrib><creatorcontrib>Behm, K. T.</creatorcontrib><creatorcontrib>Hayman, A. V.</creatorcontrib><creatorcontrib>Habermann, E. B.</creatorcontrib><creatorcontrib>Larson, D. W.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><title>Outcomes with multimodal therapy for elderly patients with rectal cancer</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Background
Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older).
Methods
This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan–Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival.
Results
A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60‐month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98).
Conclusion
A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.
Treatment should not be determined by age alone</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Combined Modality Therapy - methods</subject><subject>Epidemiologic Methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Neoplasm Staging - statistics & numerical data</subject><subject>Rectal Neoplasms - mortality</subject><subject>Rectal Neoplasms - therapy</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkMtOwzAQRS0EglJY8AMoEhs2AT_i2F1SBC3PChXE0nKciUhJmmA7gvw9Li0sWM2M5tzR6CB0RPAZwZieZwu3arjYQgPCUh5TksptNMAYi5gwyvbQvnMLjAnDnO6iPZqmKWVCDNB01nnT1OCiz9K_RXVX-bJucl1F_g2sbvuoaGwEVQ626qNW-xKWfgNbMD6ARi8N2AO0U-jKweGmDtHL9dXz5TS-n01uLi_uY5OkVMQ0yxNCAHQhhTASZyYnJrwOOUmMyTgf5WZEDE2SLJMFSBgB5zyMhcwLwjUbotP13dY2Hx04r-rSGagqvYSmc4qIFEtJCU0CevIPXTSdXYbvAsUFCZIkD9TxhuqyGnLV2rLWtle_jgJwvgY-ywr6vz3BaiVfBfnqR74a385_mpCI14nSefj6S2j7rlLBBFevjxM1ZneT-fhhrp7YNw1NhYk</recordid><startdate>201601</startdate><enddate>201601</enddate><creator>Thiels, C. A.</creator><creator>Bergquist, J. R.</creator><creator>Meyers, A. J.</creator><creator>Johnson, C. L.</creator><creator>Behm, K. T.</creator><creator>Hayman, A. V.</creator><creator>Habermann, E. B.</creator><creator>Larson, D. W.</creator><creator>Mathis, K. L.</creator><general>John Wiley & Sons, Ltd</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201601</creationdate><title>Outcomes with multimodal therapy for elderly patients with rectal cancer</title><author>Thiels, C. A. ; Bergquist, J. R. ; Meyers, A. J. ; Johnson, C. L. ; Behm, K. T. ; Hayman, A. V. ; Habermann, E. B. ; Larson, D. W. ; Mathis, K. L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4627-2bd411eeaf877c80bcd1c005ed14ccb559dc91c244bb8fe8e9e555244f8df15a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Combined Modality Therapy - methods</topic><topic>Epidemiologic Methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Neoplasm Staging - statistics & numerical data</topic><topic>Rectal Neoplasms - mortality</topic><topic>Rectal Neoplasms - therapy</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thiels, C. A.</creatorcontrib><creatorcontrib>Bergquist, J. R.</creatorcontrib><creatorcontrib>Meyers, A. J.</creatorcontrib><creatorcontrib>Johnson, C. L.</creatorcontrib><creatorcontrib>Behm, K. T.</creatorcontrib><creatorcontrib>Hayman, A. V.</creatorcontrib><creatorcontrib>Habermann, E. B.</creatorcontrib><creatorcontrib>Larson, D. W.</creatorcontrib><creatorcontrib>Mathis, K. L.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thiels, C. A.</au><au>Bergquist, J. R.</au><au>Meyers, A. J.</au><au>Johnson, C. L.</au><au>Behm, K. T.</au><au>Hayman, A. V.</au><au>Habermann, E. B.</au><au>Larson, D. W.</au><au>Mathis, K. L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes with multimodal therapy for elderly patients with rectal cancer</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2016-01</date><risdate>2016</risdate><volume>103</volume><issue>2</issue><spage>e106</spage><epage>e114</epage><pages>e106-e114</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Background
Treatment guidelines for stage II and III rectal cancer include neoadjuvant chemoradiotherapy, surgery and postoperative adjuvant chemotherapy. Although data support this recommendation in younger patients, it is unclear whether this benefit can be extrapolated to elderly patients (aged 75 years or older).
Methods
This was a retrospective review of patients aged at least 75 years with stage II or III rectal cancer who underwent surgery with curative intent from 1996 to 2013 at the Mayo Clinic. Kaplan–Meier analysis and log rank test were used to compare overall survival between therapy groups. Cox proportional hazards model was used to estimate the independent effect of treatment group on survival.
Results
A total of 160 elderly patients (median age 80 years) with stage II (66) and stage III (94) rectal cancer underwent surgical resection. Only 30·0 and 33·8 per cent received neoadjuvant or adjuvant therapy respectively. Among patients with stage II disease, there was no significant difference in 60‐month survival between patients who received any additional therapy and those who had surgery alone (55 versus 38 per cent respectively; P = 0·184), whereas additional therapy improved survival in patients with stage III tumours (58 versus 30 per cent respectively; P = 0·007). Multivariable analysis found a survival benefit for additional therapy in elderly patients with stage III disease (hazard ratio 0·58, 95 per cent c.i. 0·34 to 0·98).
Conclusion
A multimodal approach in elderly patients with stage III rectal cancer improved oncological outcomes.
Treatment should not be determined by age alone</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>26662377</pmid><doi>10.1002/bjs.10057</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Aged Aged, 80 and over Combined Modality Therapy - methods Epidemiologic Methods Female Humans Male Neoplasm Staging - statistics & numerical data Rectal Neoplasms - mortality Rectal Neoplasms - therapy Retrospective Studies Treatment Outcome |
| title | Outcomes with multimodal therapy for elderly patients with rectal cancer |
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