Background/Objectives: The application of long-course chemoradiotherapy (LCRT) in elderly patients with locally advanced rectal cancer (LARC) can be challenging due to increased risks of complications associated with comorbidities and reduced functional status. This study aimed to assess the efficacy of neoadjuvant hypofractionated chemoradiotherapy (HCRT) in elderly patients with mid-to-low LARC.Methods: We performed a retrospective review of patients diagnosed with LARC from January 2013 to December 2020 and included those aged 70 years or older. Patients were categorized into three groups based on their treatment strategies: neoadjuvant HCRT (33 or 35 Gy in 10 fractions), neoadjuvant LCRT, and upfront surgery. Comparative analyses were performed on clinicopathological characteristics, short-term outcomes, and long-term survival outcomes among these groups.Results: Among the 296 patients included, 30 (10.1%) received HCRT, 195 (65.9%) underwent standard LCRT, and 71 (24.0%) underwent upfront surgery. The baseline characteristics showed that the HCRT group had a higher American Society of Anesthesiologists (ASA) score (ASA score 3 or 4, HCRT 43.3% vs. LCRT 16.9% vs. upfront surgery 15.5%,p= 0.002). The HCRT group showed a significantly lower incidence of radiotherapy-related complications than the LCRT group (16.7% vs. 48.7%,p= 0.001). However, the rate of pathological complete response was significantly lower in the HCRT group (10.0% vs. 15.4%,p= 0.002). The 3-year relapse-free survival (83.0% vs. 77.2% vs. 83.2%;p= 0.411), 3-year local recurrence-free survival (93.1% vs. 93.2% vs. 93.5%;p= 0.464), and 5-year overall survival (65.1% vs. 67.0% vs. 67.7%;p= 0.682) were not significantly different between the three groups. Multivariate analysis also showed that the treatment strategy was not associated with survival outcomes.Conclusions: Neoadjuvant HCRT demonstrated reduced radiotherapy-related complications and acceptable long-term oncologic outcomes. Therefore, neoadjuvant HCRT may be considered as a viable alternative for elderly patients with LARC.
背景/目的：对于局部晚期直肠癌（LARC）老年患者，由于合并症相关并发症风险增加及功能状态下降，应用长程放化疗（LCRT）具有挑战性。本研究旨在评估新辅助大分割放化疗（HCRT）在中低位LARC老年患者中的疗效。方法：我们对2013年1月至2020年12月诊断为LARC的患者进行回顾性分析，纳入年龄≥70岁的患者。根据治疗策略将患者分为三组：新辅助HCRT组（33或35 Gy/10次）、新辅助LCRT组和直接手术组。比较分析三组患者的临床病理特征、短期疗效及长期生存结局。结果：在纳入的296例患者中，30例（10.1%）接受HCRT，195例（65.9%）接受标准LCRT，71例（24.0%）接受直接手术。基线特征显示HCRT组美国麻醉医师协会（ASA）评分更高（ASA评分3或4分比例：HCRT组43.3% vs. LCRT组16.9% vs. 直接手术组15.5%，p=0.002）。HCRT组放疗相关并发症发生率显著低于LCRT组（16.7% vs. 48.7%，p=0.001），但病理完全缓解率显著较低（10.0% vs. 15.4%，p=0.002）。三组间3年无复发生存率（83.0% vs. 77.2% vs. 83.2%；p=0.411）、3年局部无复发生存率（93.1% vs. 93.2% vs. 93.5%；p=0.464）及5年总生存率（65.1% vs. 67.0% vs. 67.7%；p=0.682）均无显著差异。多变量分析亦显示治疗策略与生存结局无显著关联。结论：新辅助HCRT可降低放疗相关并发症发生率，且长期肿瘤学结局可接受，可作为LARC老年患者的可行替代治疗方案。
肿瘤(癌症)患者之家