Current Treatment Approaches and Outcomes in the Management of Rectal Cancer Above the Age of 80

Abstract

Background: The number of cases of rectal cancer in our older cohort is expected to rise with our ageing population. In this study, we analysed patterns in treatment and the long-term outcomes of patients older than 80 years with rectal cancer across a health district.

Methods: All cases of rectal cancer managed at the Illawarra Cancer Care Centre, Australia between 2006 and 2018 were analysed from a prospectively maintained database. Patients were stratified into three age groups: ≤65 years, 66-79 years and ≥80 years of age. The clinicopathological characteristics, operative and non-operative treatment approach and survival outcomes of the three groups were compared.

Results: Six hundred and ninety-nine patients with rectal cancer were managed, of which 118 (17%) were aged 80 and above. Patients above 80 were less likely to undergo surgery (71% vs. 90%, p < 0.001) or receive adjuvant/neoadjuvant chemoradiotherapy (p < 0.05). Of those that underwent surgical resection, their tumours were on average larger (36.5 vs. 31.5 mm, p = 0.019) and 18 mm closer the anal verge (p = 0.001). On Kaplan-Meier analysis, those above 80 had poorer cancer-specific survival when compared to their younger counterparts (p = 0.032), but this difference was no longer apparent after the first year (p = 0.381).

Conclusion: Patients above the age of 80 with rectal cancer exhibit poorer cancer-specific survival, which is accounted for in the first year after diagnosis. Priority should be made to optimise care during this period. There is a need for further research to establish the role of chemoradiotherapy in this population, which appears to be underutilised.

Keywords: aged; chemotherapy; radiotherapy; rectal neoplasms; surgery; survival.

Figure 1

Percentage of patients with rectal cancer that received either neoadjuvant or adjuvant chemoradiotherapy concurrent with surgery. Differences between each age group within each category were significant (p < 0.05). Adj. = adjuvant, CTx = chemotherapy, Neo. = neoadjuvant, RTx = radiotherapy.

Figure 2

Kaplan–Meier analyses by age group. Above analyses included all patients, regardless of whether or not they underwent surgery (A): Overall survival. (B): Overall survival where deaths in the first year after diagnosis are excluded. (C): Cancer specific survival. (D): Cancer specific survival where deaths in the first year after diagnosis are excluded. Vertical tick marks along each survival curve indicate censorship—i.e., the last follow up where the patient was alive.

Figure 3

Disease Free survival for patients that underwent curative treatment across the three age groups. Vertical tick marks along each survival curve indicate censorship—i.e., the last follow up where there was no evidence of disease recurrence.