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Treatment of colorectal cancer in older patients

Nature Reviews Gastroenterology & Hepatology volume 9, pages 716–725 (2012)Cite this article

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Abstract

Colorectal cancer (CRC) largely affects older individuals; almost half of cases occur in patients >75 years old. The incidence increases with advancing age, doubling every 7 years in patients aged ≥50 years. The medical and societal burdens of CRC will probably worsen over the coming decades as the number of older individuals (>70) continues to grow. No evidence-based guidelines are available for this age group, as older patients with CRC are generally excluded from randomized clinical trials and the fit ones who are recruited are not representative of the general elderly population. When feasible, surgery is the most successful treatment option for eradicating the primary lesion, as well as any metastases. The operative risk under elective conditions is not markedly different in older than in younger patients; however, the acute setting is to be avoided as it is associated with high operative death rates. Well-selected older patients can tolerate chemotherapy, but benefits need to be balanced against potentially limited life expectancy and reduced quality of life. The use of combination chemotherapy is an area of much controversy, but this treatment should not necessarily be withheld because of the age of the patient. Careful monitoring of toxicities and early intervention is essential in older patients undergoing chemotherapy.

Key Points

  • Most cases of colorectal cancer (CRC) occur in patients >75 years old and active treatment should not be withheld because of a patient's age

  • No evidence-based guidelines are available, as older patients (≥70) with CRC are generally excluded from randomized controlled trials and fit patients who are recruited are not representative of the elderly population

  • Surgery is the most successful treatment option, when feasible

  • The operative risk under elective conditions is not notably different in older patients than in young patients; however, emergency surgery should be avoided as it has high death rates

  • Older patients can tolerate chemotherapy, and toxicity is not a major issue in appropriately selected patients; however, benefits must be balanced against the limited life expectancy and reduced quality of life

  • The use of geriatric assessment is mandatory for appropriate treatment planning, obtaining patient consent, comparing series, designing trials and sharing data

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Figure 1: An 87-year-old man presented with a 2-day history of acute abdominal pain.
Figure 2: Transverse CT image depicting the planning target volume for a low rectal tumour (violet line).
Figure 3: Posterior–anterior view of a digitally reconstructed radiograph depicting the planning target volume for the same patient as in Figure 2, shown in violet.

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  1. Department of Surgery, University of Liverpool, St Helens Teaching Hospital, Marshalls Cross Road, St Helens, Liverpool, WA9 3DA, UK

    Riccardo A. Audisio

  2. Department of Medical Oncology, Cyprus Oncology Center, 32 Acropoleos Avenue, 2006 Strovolos, Nicosia, Cyprus

    Demetris Papamichael

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Audisio, R., Papamichael, D. Treatment of colorectal cancer in older patients. Nat Rev Gastroenterol Hepatol 9, 716–725 (2012). https://doi.org/10.1038/nrgastro.2012.196

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