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Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older.

Publication ,  Journal Article
Margalit, DN; Mamon, HJ; Ancukiewicz, M; Kobayashi, W; Ryan, DP; Blaszkowsky, LS; Clark, J; Willett, CG; Hong, TS
Published in: Int J Radiat Oncol Biol Phys
December 1, 2011

PURPOSE: To determine the rate of treatment deviations during combined modality therapy for rectal cancer in elderly patients aged 75 years and older. METHODS AND MATERIALS: We reviewed the records of consecutively treated patients with rectal cancer aged 75 years and older treated with combined modality therapy at Massachusetts General Hospital and Brigham & Women's Hospital from 2002 to 2007. The primary endpoint was the rate of treatment deviation, defined as a treatment break, dose reduction, early discontinuation of therapy, or hospitalization during combined modality therapy. Patient comorbidity was rated using the validated Adult Comorbidity Evaluation 27 Test (ACE-27) comorbidity index. Fisher's exact test and the Mantel-Haenszel trend test were used to identify predictors of treatment tolerability. RESULTS: Thirty-six eligible patients had a median age of 79.0 years (range, 75-87 years); 53% (19/36) had no or mild comorbidity and 47% (17/36) had moderate or severe comorbidity. In all, 58% of patients (21/36) were treated with preoperative chemoradiotherapy (CRT) and 33% (12/36) with postoperative CRT. Although 92% patients (33/36) completed the planned radiotherapy (RT) dose, 25% (9/36) required an RT-treatment break, 11% (4/36) were hospitalized, and 33% (12/36) had a dose reduction, break, or discontinuation of concurrent chemotherapy. In all, 39% of patients (14/36) completed≥4 months of adjuvant chemotherapy, and 17% (6/36) completed therapy without a treatment deviation. More patients with no to mild comorbidity completed treatment than did patients with moderate to severe comorbidity (21% vs. 12%, p=0.66). The rate of deviation did not differ between patients who had preoperative or postoperative CRT (19% vs. 17%, p=1.0). CONCLUSIONS: The majority of elderly patients with rectal cancer in this series required early termination of treatment, treatment interruptions, or dose reductions. These data suggest that further intensification of combined modality therapy for rectal cancer should be performed with caution in elderly patients, who require aggressive supportive care to complete treatment.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2011

Volume

81

Issue

5

Start / End Page

e735 / e741

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rectal Neoplasms
  • Radiotherapy, Conformal
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Male
  • Humans
  • Hospitalization
  • Female
 

Citation

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Margalit, D. N., Mamon, H. J., Ancukiewicz, M., Kobayashi, W., Ryan, D. P., Blaszkowsky, L. S., … Hong, T. S. (2011). Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys, 81(5), e735–e741. https://doi.org/10.1016/j.ijrobp.2010.12.056
Margalit, Danielle N., Harvey J. Mamon, Marek Ancukiewicz, Wendy Kobayashi, David P. Ryan, Lawrence S. Blaszkowsky, Jeffrey Clark, Christopher G. Willett, and Theodore S. Hong. “Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older.Int J Radiat Oncol Biol Phys 81, no. 5 (December 1, 2011): e735–41. https://doi.org/10.1016/j.ijrobp.2010.12.056.
Margalit DN, Mamon HJ, Ancukiewicz M, Kobayashi W, Ryan DP, Blaszkowsky LS, et al. Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e735–41.
Margalit, Danielle N., et al. “Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older.Int J Radiat Oncol Biol Phys, vol. 81, no. 5, Dec. 2011, pp. e735–41. Pubmed, doi:10.1016/j.ijrobp.2010.12.056.
Margalit DN, Mamon HJ, Ancukiewicz M, Kobayashi W, Ryan DP, Blaszkowsky LS, Clark J, Willett CG, Hong TS. Tolerability of combined modality therapy for rectal cancer in elderly patients aged 75 years and older. Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):e735–e741.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

December 1, 2011

Volume

81

Issue

5

Start / End Page

e735 / e741

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Rectal Neoplasms
  • Radiotherapy, Conformal
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasm Recurrence, Local
  • Male
  • Humans
  • Hospitalization
  • Female