Thématique :
- Cancer colorectal (CCR)
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Professeur David TOUGERON
Coup de coeur :
Annals of oncology
  doi: 10.1093/annonc/mdv331  
  Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer  
  D. M. Jiang, S. Raissouni, J. Mercer, A. Kumar, R. Goodwin, D. Y. Heng, P. A. Tang, C. Doll, A. MacLean, E. Powell, J. Price-Hiller, J. Monzon, W. Y. Cheung and M. M. Vickers  


Studies of clinical outcomes of elderly patients treated with neoadjuvant chemoradiation (nCRT) for locally advanced rectal cancer (LARC) are limited. Our aim was to assess the impact of age on clinical outcomes in a large multi-institutional database.


Data for patients diagnosed with LARC who received nCRT and curative-intent surgery between 2005 and 2012 were collected from five major Canadian cancer centers. Age was analyzed as a continuous and dichotomous variable (< 70 versus ≥ 70 years) and correlated with disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS). Cox regression models were used to adjust for important prognostic factors.


Of 1172 patients included, 295 (25%) were ≥ 70 years, and they were less likely to receive adjuvant chemotherapy (ACT; 60% versus 79%, P < 0.0001), oxaliplatin-based ACT (12% versus 31%, P < 0.0001), less likely to complete nCT (76% versus 86%, P < 0.001), and more likely to be anemic at initiation of nCRT (42% versus 30%, P = 0.0004). In multivariate analyses, age ≥ 70 years was associated with similar DFS [hazard ratio (HR) 0.93, 95% confidence interval (CI) 0.68-1.26, P = 0.63], similar CSS (HR 0.81, 95% CI 0.46-1.41, P = 0.45), and similar OS (HR 1.28, 95% CI 0.88-1.86, P = 0.20), compared with the younger age group. As a continuous variable, increasing age was not predictive of DFS (HR 1.00, 95% CI 0.99-1.02, P = 0.49) or CSS (HR 1.002, 95% CI 0.98-1.02, P = 0.88); however, it correlated with an inferior OS (HR 1.02, 95% CI 1.00-1.03, P = 0.04).


Elderly patients (≥ 70 years) who receive nCRT followed by surgery appear to have similar outcomes compared with younger patients. Decisions regarding eligibility for nCRT and surgery should not be based on age alone.

Question posée
La radio-chimiothérapie (RCT) néo-adjuvante est le traitement de référence des adénocarcinomes du rectum localement avancés (T3-4 et/ou N+). Il y a peu d’étude s’intéressant aux résultats de la RCT néo-adjuvante chez les patients âgés atteints d’un adénocarcinome du rectum. Les auteurs ont comparé les résultats de la RCT chez les patients <70 versus ≥70 ans.
Question posée