SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur David TOUGERON
Coup de coeur :
 
 
Annals of oncology
  2016/01  
 
  2015 Oct;26(10):2102-6  
  doi: 10.1093/annonc/mdv331. Epub 2015 Jul 30.  
 
  Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer  
 
  Jiang DM, Raissouni S, Mercer J, Kumar A, Goodwin R, Heng DY, Tang PA, Doll C, MacLean A, Powell E, Price-Hiller J, Monzon J, Cheung WY, Vickers MM  
  http://www.ncbi.nlm.nih.gov/pubmed/26232491  
 
 

Background : 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.

Patients and methods : 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.

Results : 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).

Conclusions : 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’études 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
 
Les résultats de la RCT néo-adjuvante puis chirurgie sont identiques chez les patients âgés que chez les patients jeunes en terme de survie sans progression.
 
Commentaires

Cette étude confirme que la RCT néo-adjuvante dans les cancers du rectum peut être proposée aux patients âgés. Comme pour la plupart des traitements oncologiques, l’âge chronologique ne doit pas influencer la décision thérapeutique mais c’est plutôt les co-morbidités et l’âge physiologique qu’il faut prendre en compte.

 
www.snfge.org