MIGLIORE TRATTAMENTO DEL CARCINOMA DEL RETTO LOCALIZZATO NEL PAZIENTE ANZIANO E. Barletta, P. Federico, V. Tinessa, D. Germano, B. Daniele Vol.1 (2017), issue 4, pag. 24-31
Accepted for pubblication
Rectal cancer constitutes about 35% of all cancers of the large intestine in elderly patients. In our critical review we faced the problem of rectal carcinoma treatment that was localised and locally advanced in the elderly patient. In deciding on a course of treatment for an elderly patient, a Multidimensional Geriatric Evaluation is needed to determine whether the patient is “fragile” or “non fragile” and, therefore, to identify the most appropriate treatment. Fit patients are treated in the same way as young patients. Rectal cancer is a disease that requires multidisciplinary integration between surgeons, oncologists and radiation oncologists. For stage I, the treatment is exclusively surgical. For clinical stage II, the applicable treatment is neoadjuvant radio-chemotherapy followed by TME, and the initial surgical treatment is indicated for stenosing or bleeding tumors. The stage II disease pT3 pathology requires post-operative radiotherapy. For clinical stage III, the treatment is chemo radiotherapy followed by TME and then CTA. Concurrent chemotherapy and radiotherapy treatment is administered by Capecitabine or continuous infusion of 5-fluorouracil. Radiation therapy schedule with a long cycle consists of: 40-50.4 Gy total in 25-28 fractions of 1.8 Gy/day, or along with a short-course 5 Gy/day in 5 fractions of total 25 Gy. Adjuvant chemotherapy is indicated in stage III, the patterns shown in patients aged > 75 years are: 5-FU and capecitabine (de Gramont), XELOX or FOLFOX schemes have given only a small incremental benefit in studies on a subset of elderly patients. In conclusion, we can say that the best treatment comes from the best selection (VGM) of elderly patients as candidates for radical treatment.