Management of locally advanced rectal cancer in the elderly: a critical review and algorithm

Abstract

Colorectal cancer incidence and death rates have been declining over the past 10 years. However, it remains the second leading cause of death in men ages 60-79 and the third leading cause of death in men over 80 and in women over 60 years old. However, there is little data specific to the treatment of the elder patient, since few of these patients are included in trials. With the advent of improved therapies, there are many alternative options available. Still, no definitive consensus or guidelines have been defined for this particular patient population. The goal of this study is to review the literature on the management of rectal cancer in the elderly and to propose treatment algorithms to help the oncology team in treatment decision-making.

Keywords: Rectal cancer; elderly; treatment algorithm.

Figure 1

Treatment algorithm for elderly patients with rectal cancer. *, consider infusional 5-FU if polypharmacy or difficultly with adherence with medications. APR, abdominoperineal resection; LAR, lower abdominal resection; TEM, transanal endoscopic microsurgery; LVI, lymphovascular invasion; RT, radiation therapy; HDR, high-dose rate.