Should radiotherapy be avoided or delivered differently in elderly patients with rectal cancer?

Purpose is to give an overview of treatment possibilities of rectal cancer over time, but also of the real management of rectal cancer especially in relation to age. From literature search representative randomised studies on patients with resectable rectal cancer, comparing only surgery, post- and preoperative radiotherapy with or without chemotherapy, are reviewed. We also reviewed the literature regarding radiotherapy for rectal cancer described in population-based studies. The overview of the trials showed that preoperative radiotherapy improves local control in relation to no or postoperative radiotherapy. Adding chemotherapy did not significantly improve survival. No relations were seen between age and complications. All population-based studies showed that increasing age is associated with less (neo)adjuvant treatment. To avoid local recurrence, the best possible treatment, being preoperative RT, should be given to all patients with resectable rectal cancer, irrespective of age.