2135 - Impact of Neoadjuvant Chemoradiation on Clinical Outcomes in Elderly Patients with Locally Advanced Rectal Cancer
Presenter(s)
T. Lin1, C. C. Yang1, T. M. Ke2, C. H. Ho3, and Y. C. Chen3; 1Department of Radiation Oncology Chi-Mei Medical Center, Tainan, Taiwan, 2Chimei Medical Center, Tainan, Taiwan, 3Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
Purpose/Objective(s): Neoadjuvant therapy followed by surgery is the standard management for locally advanced rectal cancer (LARC). However, its utility in the elderly remains debated. This study evaluates the indispensable role of neoadjuvant chemoradiation (nCCRT) in elderly LARC patients undergoing surgical resection.
Materials/Methods: The cohort included 5,533 patients (>65 years) diagnosed with LARC and treated with surgery (2008–2017). Patients were stratified by receipt of nCCRT (N=4,477) versus surgery alone (N=1,088). Cox proportional hazard models and stratified analyses were utilized to compare local recurrence, overall survival (OS), and disease-free survival (DFS).
Results: Elderly patients receiving nCCRT were typically younger (65–75), male, and had fewer comorbidities. While multi-variable analysis showed no significant advantage in OS or DFS (P < 0.05), the pathological impact of nCCRT was profound. Patients receiving neoadjuvant therapy achieved significantly higher rates of tumor down-staging (P < 0.05), directly facilitating more precise surgical interventions.
Conclusion: For elderly LARC patients, neoadjuvant chemoradiation is a critical driver for achieving down-staging resection. Although survival metrics remained comparable, the biological effect of RT/CCRT in shrinking tumors is essential for optimizing surgical margins and improving resectability. Clinicians must prioritize nCCRT to ensure the highest quality of surgical outcomes and local disease control.