A clinical study of adjuvant chemotherapy in younger and elder rectal cancer patientsA

Maja Zemmler, Maria Albertsson & Annica Holmqvist *

The role of postoperative chemotherapy (CT) is still unclear and the evidence for recommendations of adjuvant therapy in rectal cancer (RC) is sparse. The aim of this study was to investigate the outcome and tolerability of postoperative adjuvant CT in a clinical study of patients with RC ≥ 69 or <69 years. Two hundred and thirty one patients with stage II-IV rectal adenocarcinoma from the South East Health Care Region of Sweden were included in this retrospective nested case control study. The patients received radiotherapy (RT) or chemoradiation (CRT) followed by surgery. Seventy-six patients were subjected to postoperative adjuvant CT. In all patients and in patients ≥ 69 years, patients with capecitabine had an improved overall survival (OS) and cancer specific survival (CSS) compared to patients without adjuvant CT (p=0.01, p=0.02), (p=0.03, p=0.05) independent of sex, age, TNM stage, differentiation grade and preoperative RT (p=0.003, HR 0.29, p=0.002, HR 0.13, p=0.006, HR 0.26, p=0.007, HR 0.13, 95% CI), but not in patients <69 years (p>0.05). In patients ≥ 69 years, treatment with capectiabine/oxaliplatin were related to worse CSS compared to patients with capectiabine alone (p=0.02). Fifty seven percent of the patients with capectiabine/oxaliplatin and 17% with capecitabine alone had to stop the treatment due to severe side effects. Adjuvant capecitabine is related to better OS and CSS in RC patient’s ≥ 69 years. Oxaliplatin containing regimen should be administered with caution, especially in elderly patients.