Rutten Harm J T, den Dulk Marcel, Lemmens Valery E P P, van de Velde Cornelis J H, Marijnen Corrie A M
Department of Surgery, Catharina Hospital, Eindhoven, Netherlands.
Lancet Oncol. 2008 May;9(5):494-501. doi: 10.1016/S1470-2045(08)70129-3.
The cornerstone of treatment for rectal cancer is resectional treatment according to the principles of total mesorectal excision (TME). However, population-based registries show that improvements in outcome after resectional treatment occur mainly in younger patients. Furthermore, 6-month postoperative mortality is significantly increased in elderly patients (> or = 75 years of age) compared with younger patients (< 75 years of age). Several confounding factors, such as treatment-related complications and comorbidity, are thought to be responsible for these disappointing findings. Thus, major resectional treatment is not advantageous for all older patients with rectal cancer. However, the Dutch TME trial showed a good response to a short course of neoadjuvant radiotherapy in elderly patients. Biological responses to cancer treatment seem to change with age, and, therefore, individualised cancer treatments should be used that take into account the heterogeneity of ageing. For elderly patients who retain a good physical and mental condition, treatment that is given to younger patients is deemed appropriate, whereas for those with diminished physiological reserves and comorbid conditions, alternative treatments that keep surgical trauma to a minimum and optimise the use of radiotherapy might be more suitable.
直肠癌治疗的基石是根据全直肠系膜切除（TME）原则进行切除治疗。然而，基于人群的登记数据显示，切除治疗后预后的改善主要发生在年轻患者中。此外，与年轻患者（<75岁）相比，老年患者（≥75岁）术后6个月死亡率显著增加。一些混杂因素，如治疗相关并发症和合并症，被认为是导致这些令人失望结果的原因。因此，对于所有老年直肠癌患者而言，主要的切除治疗并非都具有优势。然而，荷兰TME试验显示老年患者对短程新辅助放疗反应良好。癌症治疗的生物学反应似乎随年龄而变化，因此，应采用个体化癌症治疗，同时考虑到衰老的异质性。对于身体和精神状况良好的老年患者，给予年轻患者的治疗被认为是合适的，而对于生理储备减少和有合并症的患者，将手术创伤降至最低并优化放疗使用的替代治疗可能更合适。
