Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA.
PLoS One. 2013 Aug 13;8(8):e71250. doi: 10.1371/journal.pone.0071250. eCollection 2013.
The study aims to assess the tolerance of elderly patients (70 years or older) with locally advanced rectal cancers to image-guided radiotherapy (IGRT). A retrospective review of 13 elderly patients with locally advanced rectal cancer who underwent preoperative chemoradiation using IGRT was performed. Grade 3-4 acute toxicities, survival, and long-term complications were compared to 17 younger patients (<70 years) with the same disease stage.
Grade 3-4 hematologic toxicities occurred in 7.6% and 0% (p = 0.4) and gastrointestinal toxicities, and, in 15.2% and 5% (p = 0.5), of elderly and younger patients, respectively. Surgery was aborted in three patients, two in the elderly group and one in the younger group. One patient in the elderly group died after surgery from cardiac arrhythmia. After a median follow-up of 34 months, five patients had died, two in the elderly and three in the younger group. The 3-year survival was 90.9% and 87.5% (p = 0.7) for the elderly and younger group respectively. Two patients in the younger group developed ischemic colitis and fecal incontinence. There was no statistically significant difference in acute and late toxicities as well as survival between the two groups.
Elderly patients with locally advanced rectal cancers may tolerate preoperative chemoradiation with IGRT as well as younger patients. Further prospective studies should be performed to investigate the potential of IGRT for possible cure in elderly patients with locally advanced rectal cancer.
本研究旨在评估高龄（≥70 岁）局部晚期直肠癌患者对图像引导放疗（IGRT）的耐受性。回顾性分析了 13 例接受术前放化疗联合 IGRT 的局部晚期直肠癌老年患者，比较了他们与同期疾病阶段的 17 例年轻患者（＜70 岁）的 3-4 级急性毒性、生存情况和长期并发症。
老年组和年轻组的 3-4 级血液学毒性发生率分别为 7.6%和 0%（p=0.4），胃肠道毒性发生率分别为 15.2%和 5%（p=0.5）。3 例患者因手术取消，其中 2 例来自老年组，1 例来自年轻组。1 例老年患者术后死于心律失常。中位随访 34 个月后，共有 5 例患者死亡，其中老年组 2 例，年轻组 3 例。老年组和年轻组的 3 年生存率分别为 90.9%和 87.5%（p=0.7）。年轻组有 2 例患者发生缺血性结肠炎和大便失禁。两组之间的急性和迟发性毒性以及生存情况无统计学差异。
局部晚期直肠癌老年患者可耐受术前放化疗联合 IGRT，与年轻患者相似。应进一步开展前瞻性研究，以探讨 IGRT 对局部晚期直肠癌老年患者潜在治愈的可能性。
