Kordatou Z, Kountourakis P, Papamichael Demetris
Department of Medical Oncology, BOC Oncology Centre, Nicosia, Cyprus.
Director, Department of Medical Oncology, BOC Oncology Centre, Nicosia, Cyprus.
Ther Adv Med Oncol. 2014 May;6(3):128-40. doi: 10.1177/1758834014523328.
In a continuously aging population, the burden of colorectal cancer (CRC) is rising among older patients. Despite the fact that almost half of the cases occur in patients over 75 years, this age group is subjected to disparities regarding diagnostic and therapeutic options. So far, exclusion of older patients from randomized clinical trials has resulted in a lack of evidence-based guidelines. Nevertheless, newer data from studies specifically targeting older patients and subgroup analyses indicate that proper treatment planning and specific medical and geriatric assessment can achieve a safe and beneficial treatment result in older patients, often with similar outcomes to their younger counterparts. Resection of the primary tumour, if feasible, should be the primary goal of surgery aiming for cure, although it should be avoided under emergency conditions. Chronological age per se should not be an exclusion criterion for adjuvant or palliative chemotherapy, or targeted therapies. Careful patient selection, dose adjustments, close monitoring and early intervention in the event of side effects are essential. The benefits of treatment must be balanced with potential effects of treatment and patients' wishes.
在人口持续老龄化的情况下，老年患者结直肠癌（CRC）的负担正在上升。尽管几乎一半的病例发生在75岁以上的患者中，但该年龄组在诊断和治疗选择方面存在差异。到目前为止，将老年患者排除在随机临床试验之外导致缺乏循证指南。然而，专门针对老年患者的研究和亚组分析的最新数据表明，适当的治疗规划以及特定的医学和老年医学评估能够在老年患者中实现安全且有益的治疗效果，其结果往往与年轻患者相似。如果可行，切除原发肿瘤应是旨在治愈的手术的主要目标，不过在紧急情况下应避免。实际年龄本身不应成为辅助或姑息化疗或靶向治疗的排除标准。仔细的患者选择、剂量调整、密切监测以及出现副作用时的早期干预至关重要。治疗的益处必须与治疗的潜在影响以及患者的意愿相平衡。
