Decision-Making Strategy for Rectal Cancer Management Using Radiation Therapy for Elderly or Comorbid Patients

Abstract

Rectal cancer predominantly affects patients older than 70 years, with peak incidence at age 80 to 85 years. However, the standard treatment paradigm for rectal cancer oftentimes cannot be feasibly applied to these patients owing to frailty or comorbid conditions. There are currently little information and no treatment guidelines to help direct therapy for patients who are elderly and/or have significant comorbidities, because most are not included or specifically studied in clinical trials. More recently various alternative treatment options have been brought to light that may potentially be utilized in this group of patients. This critical review examines the available literature on alternative therapies for rectal cancer and proposes a treatment algorithm to help guide clinicians in treatment decision making for elderly and comorbid patients.

Fig. 1.

Proposed treatment algorithm for locally advanced rectal cancer in elderly/comorbid patients. Abbreviations: 5-FU = 5-fluorouracil; ADLs = activities of daily living; cCR = clinical complete response; CGA = comprehensive geriatric assessment; CIRS-G = Cumulative Illness Rating Scale–Geriatric; CRM = circumferential resection margins; CRT = chemoradiation; EBRT = external beam radiation therapy; DRE = digital rectal examination; ERUS = endorectal ultrasound; IADLs = instrumental activities of daily living; MGA = multidimensional geriatric assessment; RT = radiation therapy.