Should Neoadjuvant Chemoradiotherapy be Eliminated in Elderly Rectal Cancer Patients? A Review of the NCDB
*Ayana Allard-Picou, *Shiva K Mukkamalla, *John Hardaway, *Ritesh Rathore, N. Joseph Espat, Ponnandai Somasundar
Roger Williams Medical Center, Providence, RI
Objective: Standard of care for locally advanced rectal cancer (T3-4 or N1-2) includes neoadjuvant chemoradiotherapy (CRT) and surgical resection. Elderly patients (≥65 years) comprise majority of new rectal cancers but many are unable to tolerate neoadjuvant CRT resulting in delays to surgery. We evaluate the impact of neoadjuvant CRT on elderly rectal cancer patients. Design: Retrospective review. Patients receiving preoperative CRT were compared to those receiving postoperative CRT and those receiving surgery alone. Subgroup analyses were performed on elderly and very elderly (≥75 years). Statistical analyses performed using Pearson Chi-square and multivariate logistic regression. Setting: We utilized data from NCDB, including various institution types (community and academic programs in rural and urban settings). Patients: All patients with rectal cancer who underwent surgical resection from 2006-2009, with 8,656 patients meeting criteria. Excluded patients with stage IV disease. Interventions: n/a Main Outcome: Overall Survival Results: Overall, 64.6% patients received chemotherapy (58.1%: multi-drug regimen), 32.7% of patients received radiotherapy. Very elderly patients exhibited worse OS compared to elderly (HR 0.58), and to patients 18-64 years (HR 0.36), p<0.0001. Patients who underwent treatment with systemic chemotherapy (single/multi-agent) demonstrated better OS compared to surgery alone patients (HR multi-agent: 0.56, p=0.001; single agent: 0.61, p=0.006). On multivariate, patients receiving preoperative CRT exhibited worse OS compared to those receiving postoperative CRT (HR 0.64, p<0.0001) (Figure 1). Radiation did not have a significant survival impact (HR 0.98, p.32). Conclusion: Consideration should be given to eliminating neoadjuvant CRT in the elderly and when administered, should be done with caution. 
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