Chemotherapy in elderly patients with colorectal cancer

Background: Colorectal cancer is usually diagnosed in patients around 70 ye ars of age. With a continuous increase in life expectancy we may expect a h igher number of elderly patients in the future. Because patients above 70 o r 75 years are often excluded there is uncertainty as to what extent system ic adjuvant and palliative treatment should be offered to elderly patients. Methods: We reviewed the available literature on adjuvant and metastatic co lorectal cancer in order to identify reports on elderly patients treated wi thin chemotherapy trials. Results: Only about 20% of patients entering clinical trials belong to the age group of over 70 years and represent the minority of the very fit patie nts. Compared to their younger counterparts 5-FU-based treatment appears to be equally effective and more toxic according to some reports. Data regard ing raltitrexed, oral fluoropyrimidines, topoisomerase I inhibitors or DACH -platin derivates are limited but suggest no age-specific differences in ac tivity or toxicity. Conclusions: Elderly patients should not be excluded from clinical trials a nd studies in unfit elderly patients are warranted. Elderly patients need m ore attention regarding their functional, social and mental status. Fit eld erly patients should be offered adjuvant or palliative chemotherapy.