A Retrospective Cohort Study of neoadjuvant chemotherapy in elderly oncology patients with colorectal cancer

Ryo Ito; E. Watanabe; T. Nakamura

doi:10.5281/zenodo.22813193

Authors

Ryo Ito Department of Oncology, Rhine Institute for Advanced Oncology Author https://orcid.org/2645-3996-3512-3093
E. Watanabe Department of Oncology, Amazon Institute of Cancer Therapeutics Author https://orcid.org/8822-0830-1295-7076
T. Nakamura Division of Oncology, Lena Academy of Cancer Therapeutics Author https://orcid.org/0681-4965-8365-6637

DOI:

https://doi.org/10.5281/zenodo.22813193

Keywords:

colorectal cancer, neoadjuvant chemotherapy, elderly, geriatric oncology, retrospective cohort study

Abstract

Graphical abstract

Background: Elderly patients have historically been underrepresented in the trials establishing neoadjuvant chemotherapy for locally advanced colorectal cancer [1,2], leaving uncertainty about its risk-benefit balance in routine practice.

Objective: To compare surgical, toxicity, and survival outcomes of neoadjuvant chemotherapy versus upfront surgery in elderly colorectal cancer patients.

Methods: We retrospectively identified 248 patients aged 70 or older with locally advanced colon or rectal cancer at three centers (2013-2021), forming 124 propensity-matched pairs receiving neoadjuvant chemotherapy or upfront surgery.

Results: The neoadjuvant cohort achieved higher R0 resection rates (91% vs 82%, p=0.04) and improved 3-year disease-free survival (68% vs 54%, adjusted HR 0.66) and overall survival (74% vs 63%, adjusted HR 0.69) compared with upfront surgery, but treatment-limiting toxicity occurred in 31% of neoadjuvant patients, most strongly predicted by baseline frailty rather than age alone [29,12].

Conclusions: Neoadjuvant chemotherapy conferred a surgical and survival benefit in elderly colorectal cancer patients comparable to that reported in younger trial populations, but should be paired with routine geriatric and frailty assessment to individualize regimen intensity in this undertreated population [13,30].

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