Ayesha R Sheikh1, Hassan Yameen2, Kevan Hartshorn2. 1. Section of Hematology/Oncology, Boston University Medical Center, FGH building, 1st floor, 820 Harrison Avenue, Boston, MA, 02118, USA. Ayesha.sheikh@bmc.org. 2. Section of Hematology/Oncology, Boston University Medical Center, FGH building, 1st floor, 820 Harrison Avenue, Boston, MA, 02118, USA.
Abstract
PURPOSE OF REVIEW: Rectal cancer is predominantly a disease of older adults but current guidelines do not incorporate the associated specific challenges leading to wide variation in the delivery of cancer care to this subset of population. Here, we will review the current data available regarding the management of rectal cancer in older adults. RECENT FINDINGS: The greatest challenge arises in the management of stage II/III disease as it involves tri-modality treatment that can be harder to tolerate by frail older patients. Response to neoadjuvant treatment is being used as a new marker to tailor further therapy and possibly avoid surgery. Oxaliplatin can be omitted from the adjuvant treatment without compromising outcomes. Physicians should perform geriatric assessment utilizing many validated tools available to help predict treatment tolerability and outcomes in older adults that can help personalize subsequent management. Most older adults can undergo standard therapy for stages I, II, or III rectal cancer with curative intent. Increasing evidence suggests that patients with a clinical complete response to neoadjuvant treatment may be observed closely with the possibility of avoiding surgery. Studies are evaluating alternate systemic treatments for advanced metastatic disease with the hope of maintaining quality of life without compromising cancer outcomes.
PURPOSE OF REVIEW: Rectal cancer is predominantly a disease of older adults but current guidelines do not incorporate the associated specific challenges leading to wide variation in the delivery of cancer care to this subset of population. Here, we will review the current data available regarding the management of rectal cancer in older adults. RECENT FINDINGS: The greatest challenge arises in the management of stage II/III disease as it involves tri-modality treatment that can be harder to tolerate by frail older patients. Response to neoadjuvant treatment is being used as a new marker to tailor further therapy and possibly avoid surgery. Oxaliplatin can be omitted from the adjuvant treatment without compromising outcomes. Physicians should perform geriatric assessment utilizing many validated tools available to help predict treatment tolerability and outcomes in older adults that can help personalize subsequent management. Most older adults can undergo standard therapy for stages I, II, or III rectal cancer with curative intent. Increasing evidence suggests that patients with a clinical complete response to neoadjuvant treatment may be observed closely with the possibility of avoiding surgery. Studies are evaluating alternate systemic treatments for advanced metastatic disease with the hope of maintaining quality of life without compromising cancer outcomes.
Entities:
Keywords:
Neoadjuvant chemoradiation; Older adults; Pre-treatment risk assessment; Rectal cancer; Rectal cancer surgery; Watch and wait
Authors: Robert J Mayer; Eric Van Cutsem; Alfredo Falcone; Takayuki Yoshino; Rocio Garcia-Carbonero; Nobuyuki Mizunuma; Kentaro Yamazaki; Yasuhiro Shimada; Josep Tabernero; Yoshito Komatsu; Alberto Sobrero; Eveline Boucher; Marc Peeters; Ben Tran; Heinz-Josef Lenz; Alberto Zaniboni; Howard Hochster; James M Cleary; Hans Prenen; Fabio Benedetti; Hirokazu Mizuguchi; Lukas Makris; Masanobu Ito; Atsushi Ohtsu Journal: N Engl J Med Date: 2015-05-14 Impact factor: 91.245
Authors: Danielle N Margalit; Harvey J Mamon; Marek Ancukiewicz; Wendy Kobayashi; David P Ryan; Lawrence S Blaszkowsky; Jeffrey Clark; Christopher G Willett; Theodore S Hong Journal: Int J Radiat Oncol Biol Phys Date: 2011-03-04 Impact factor: 7.038
Authors: Daniel G Haller; Josep Tabernero; Jean Maroun; Filippo de Braud; Timothy Price; Eric Van Cutsem; Mark Hill; Frank Gilberg; Karen Rittweger; Hans-Joachim Schmoll Journal: J Clin Oncol Date: 2011-03-07 Impact factor: 44.544
Authors: Uday Bharat Patel; Gina Brown; Harm Rutten; Nicholas West; David Sebag-Montefiore; Robert Glynne-Jones; Eric Rullier; Marc Peeters; Eric Van Cutsem; Sergio Ricci; Cornelius Van de Velde; Pennert Kjell; Philip Quirke Journal: Ann Surg Oncol Date: 2012-04-24 Impact factor: 5.344
Authors: Matthew T Seymour; Lindsay C Thompson; Harpreet S Wasan; Gary Middleton; Alison E Brewster; Stephen F Shepherd; M Sinead O'Mahony; Timothy S Maughan; Mahesh Parmar; Ruth E Langley Journal: Lancet Date: 2011-05-11 Impact factor: 79.321