Colorectal cancer (CRC) poses a significant global health challenge. Notably, the risk of CRC escalates with age, with the majority of cases occurring in those over the age of 65. Despite recent progress in tailoring treatments for early and advanced CRC, there is a lack of prospective data to guide the management of older patients, who are frequently underrepresented in clinical trials. This article reviews the contemporary landscape of managing older individuals with CRC, highlighting recent advancements and persisting challenges. The role of comprehensive geriatric assessment is explored. Opportunities for treatment escalation/de-escalation, with consideration of the older adult’s fitness level. are reviewed in the neoadjuvant, surgical, adjuvant, and metastatic settings of colon and rectal cancers. Immunotherapy is shown to be an effective treatment option in older adults who have CRC with microsatellite instability. Promising new technologies such as circulating tumor DNA and recent phase III trials adding later-line systemic therapy options are discussed. Clinical recommendations based on the data available are summarized. We conclude that deliberate efforts to include older individuals in future colorectal cancer trials are essential to better guide the management of these patients in this rapidly evolving field.
结直肠癌（CRC）是全球面临的重大健康挑战。值得注意的是，结直肠癌的发病风险随年龄增长而升高，多数病例发生在65岁以上人群中。尽管近年来针对早期和晚期结直肠癌的个体化治疗已取得进展，但目前仍缺乏前瞻性数据来指导老年患者的临床管理，而这类患者在临床试验中的代表性往往不足。本文综述了当前老年结直肠癌患者的管理现状，重点探讨了最新进展与持续存在的挑战。文中分析了综合老年评估在临床实践中的作用，并系统回顾了结肠癌与直肠癌在新辅助治疗、手术治疗、辅助治疗及转移性治疗阶段，根据老年患者体能状态进行强化或减量化治疗的临床路径。研究证实，免疫治疗对于具有微卫星不稳定特征的老年结直肠癌患者是有效的治疗选择。文章还讨论了循环肿瘤DNA等新兴技术的前景，以及近期为后线系统治疗提供新选择的III期临床试验。基于现有证据，本文总结了临床实践建议。我们强调，在未来结直肠癌临床试验中有意识地纳入老年患者，对于在这个快速发展的领域中更好地指导这类患者的临床管理至关重要。
Updates on the Management of Colorectal Cancer in Older Adults
肿瘤(癌症)患者之家