Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes

A trimodal treatment approach for elderly patients with locally advanced rectal cancer remains a hotly debated topic. We investigated an intensified neoadjuvant chemoradiotherapy regimen. The results were encouraging, with good treatment tolerance, low severe toxicity rates, and valid 5-year survival outcomes. Intensified neoadjuvant treatment could be proposed for elderly patients with locally advanced rectal cancer. Introduction: We report the treatment compliance, toxicity rates, and long-term clinical outcomes of elderly patients who received intensified neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC). Patients and Methods: We identified a retrospective cohort of patients aged >= 70 years with LARC who received intensified neoadjuvant CRT, followed by surgery and adjuvant chemotherapy, from 2007 to 2014. Intensified neoadjuvant CRT consisted of radiotherapy (total dose, 50.4/54 Gy) with concomitant oxaliplatin (50 mg/m(2)/wk) and 5-fluorouracil (200 mg/m(2) in 5 daily continuous infusion). Results: A total of 26 patients were included. All patients completed the programmed CRT. Severe acute toxicity was recorded in 19.2% of cases. Conservative surgery was performed in 16 patients, and a pathologic complete response was achieved in 19.2%. Overall, 26.9% of the patients died. The 5-year overall survival and disease-free survival rates were 70.6% and 65.5%, respectively. Conclusions: Intensified neoadjuvant CRT is an efficacious and safe treatment option for LARC in elderly patients.