Treatment of Rectal Cancer in Older Adults. Curr Oncol Rep. 2018;20:102. [PMID: 30456634 DOI: 10.1007/s11912-018-0746-2]

Results of radical treatment of locally advanced rectal cancer in geriatric and non-geriatric patients

BACKGROUND

It is estimated that 60% of new rectal cancer cases will be diagnosed in patients ≥ 65 years old. The geriatric patient is heterogeneous and underrepresented in clinical trials, and oncologic therapies are often tailored with little evidence. We describe a cohort of patients diagnosed with locally advanced rectal cancer in geriatric and non-geriatric patients.

MATERIALS AND METHODS

Retrospective and descriptive analysis of 137 patients, 44 (32.1%) ≥ 75 years old and 93 (67.9%) ≤ 75 years old, with diagnosis of locally advanced rectal cancer. All patients received neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy.

RESULTS

Mean age was 79.5 for ≥ 75 years and 62.7 for ≤ 75 years, tumor location was: upper rectum (16.1% and 11.3%), middle rectum (60.2% and 47.7%) and lower rectum (23.7% and 41%), using the Eastern Cooperative Oncology Group (ECOG) 0: 74.1% and 81.8%, ECOG 1: 25.9% and 18.2%. Pathological complete response was 21.5% and 22.7%, partial response, 57% and 59% and no response, 21.5% and 18.3%, respectively. Tumor shrinkage in both groups after neoadjuvant treatment was 34.5% and 35.46%. Local recurrence was 2.2% and 3.2% and distance recurrence, 11.3% and 8.6%, respectively.

CONCLUSION

The study shows similar outcomes in both groups following radical treatment, with similar rates of pathological complete response. However, it has notable limitations, including a small sample size and the absence of a comprehensive geriatric assessment. To enhance these findings, future research should involve larger patient cohorts with comparative analysis and clinical trials specifically focused on the geriatric population.

Geriatric Approaches to Rectal Cancer: Moving Towards a Patient-Tailored Treatment Era

Rectal cancer is a significant global health concern, particularly amongst the elderly population, with rectal cancer accounting for approximately one-third of cancer cases in this population. Older adults often present with advanced disease stages and unique clinical manifestations, such as tumors closer to the anal verge and with greater size. Diagnosis typically involves a series of screening and imaging strategies, culminating in accurate staging through pelvic MRI, endoscopic ultrasound, and CT scan. Management of rectal cancer in older adults emphasizes individualized treatment plans that consider both the cancer stage and the patient's overall health status, including frailty and comorbidities. A multidisciplinary approach, including a mandatory geriatric assessment, is essential for optimizing outcomes, in order to improve survival and quality of life for elderly patients with rectal cancer.

The Role of Frailty in the Treatment of Locally Advanced Rectal Cancer

Owing to the gradual aging of today's population, an increase in the prevalence of frailty syndrome has been noticed. This complex state of health, characterized by decreased resilience and tolerance with concurrent increased vulnerability to stressors and adverse health-related factors, has drawn researchers' attention in recent years. Rectal cancer, which constitutes ~30% of all colorectal cancers, is a disease noticeably related to the elderly. In its locally advanced form, it is conventionally treated with trimodal therapy-neoadjuvant chemoradiotherapy followed by total mesorectal excision and adjuvant chemotherapy. Despite its good clinical outcomes and improvement in rectal cancer local control, as evidenced by clinical trials, it remains unclear if all frail patients benefit from that approach since it may be associated with adverse side effects that cannot be handled by them. As old patients, and frail ones even more noticeably, are poorly represented in the clinical trials describing outcomes of the standard treatment, this article aims to review the current knowledge on the trimodal therapy of rectal cancer with an emphasis on novel approaches to rectal cancer that can be implemented for frail patients.

Circular RNA circ_ABCB10 in cancer

Circular RNA (circRNA), a newly discovered type of endogenous noncoding RNA, has become a focus and hotspot in biological research in recent years. It exists widely and possesses a stable structure, is highly conserved and has cell-specific expression. circRNA is associated with disease occurence in general and cancer specifically due to its role in cell differentiation, proliferation, invasion and metastasis. Recently, circ_ABCB10, an increasingly studied member of the annular RNA family, has attracted considerable attention due to the fact that its expression is upregulated in various tumors, ie, esophageal cancer, breast cancer, lung cancer, and glioma, and may be of prognostic value. Molecular regulation and mechanism of circ_ABCB10 action in cancer are reviewed and its potential as a molecular marker and novel target for diagnosis and treatment are explored..

Radiomics of rectal cancer for predicting distant metastasis and overall survival

BACKGROUND

Rectal cancer (RC) patient stratification by different factors may yield variable results. Therefore, more efficient prognostic biomarkers are needed for improved risk stratification, personalized treatment, and prognostication of RC patients.

AIM

To build a novel model for predicting the presence of distant metastases and 3-year overall survival (OS) in RC patients.

METHODS

This was a retrospective analysis of 148 patients (76 males and 72 females) with RC treated with curative resection, without neoadjuvant or postoperative chemoradiotherapy, between October 2012 and December 2015. These patients were allocated to a training or validation set, with a ratio of 7:3. Radiomic features were extracted from portal venous phase computed tomography (CT) images of RC. The least absolute shrinkage and selection operator regression analysis was used for feature selection. Multivariate logistic regression analysis was used to develop the radiomics signature (Rad-score) and the clinicoradiologic risk model (the combined model). Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC. The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.

RESULTS

A total of 51 (34.5%) patients had distant metastases, while 26 (17.6%) patients died, and 122 (82.4%) patients lived at least 3 years post-surgery. The values of both the Rad-score (consisted of three selected features) and the combined model were significantly different between the distant metastasis group and the non-metastasis group (0.46 ± 0.21 vs 0.32 ± 0.24 for the Rad-score, and 0.60 ± 0.23 vs 0.28 ± 0.26 for the combined model; P < 0.001 for both models). Predictors contained in the combined model included the Rad-score, pathological N-stage, and T-stage. The addition of histologic grade to the model failed to show incremental prognostic value. The combined model showed good discrimination, with areas under the curve of 0.842 and 0.802 for the training set and validation set, respectively. For the survival analysis, the combined model was associated with an improved OS in the whole cohort and the respective subgroups.

CONCLUSION

This study presents a clinicoradiologic risk model, visualized in a nomogram, that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.