IS CHEMORADIATION FEASIBLE IN ELDERLY PATIENTS - A STUDY OF 17 PATIENTS WITH ANORECTAL CARCINOMA

BACKGROUND. Cancer in the elderly is becoming an increasing public hea lth problem. Nevertheless, several authors have noted the relative lac k of information regarding the treatment of cancer in the elderly. The aim of this study was to determine the tolerance of concomitant chemo radiation in patients age greater than or equal to 75 years with anore ctal carcinoma. METHODS. The patients were selected for treatment on t he basis of the absence of major concurrent diseases, normal blood cou nt values, good cardiac and renal function, and good general condition (defined as not requiring personal assistance). Seventeen patients (8 men and 9 women with a median age of 79 years [range, 75-90 years]) w ere treated with concomitant chemoradiation (bolus mitomycin C, 10 mg/ m(2) on Day 1 and continuous infusion 5-fluorouracil [5-FU], 1000 mg/m (2) for 24 hours on Days 1-4 [FUMIR]). The doses and volumes of pelvic radiation therapy ranged between 38-45 grays according to the primary tumor site and the intent of treatment (curative vs. palliative). RES ULTS, The total incidence of Radiation Therapy Oncology Group Grade 3 acute toxicity was 18% (3 of 17 patients). Only 1 patient (6%) was una ble to complete the treatment course. With a median follow-up of 26 mo nths, no severe late toxicity was recorded. Sixteen of 17 had > 50% re duction in the greatest dimension of the lesion, 6 patients had a comp lete response (2 rectal and 4 anal tumors), and 12 patients preserved their sphincter function. Of the four patients who had presented with pelvic pain, all had pain relief. Of the six patients who had presente d with rectal bleeding, the bleeding was controlled in five patients. CONCLUSIONS. Concomitant chemoradiation according to the FUMIR schedul e used in selected patients age greater than or equal to 75 years with anorectal carcinoma can be performed safely. (C) 1997 American Cancer Society.