LA TERAPIA ADIUVANTE DEL CANCRO DEL COLON NEL PAZIENTE ANZIANO R. Labianca, G. Piacentini, C. Sansi, A. Labianca, S. Mosconi, E. Arnoldi Vol.3 (2018), issue 2, pag.11-16
Accepted for pubblication
Incidence of colorectal cancer increases with advancing age and median age at diagnosis is 72 years. The benefit of adjuvant chemotherapy, with fluorouracil or capecitabine with or without oxaliplatin, has been established in many clinical trials. The impact of adjuvant chemotherapy on survival in older adults is not well defined, given that only a small percentage (< 10 %) of elderly patients (> 70 years) is included in these studies. Data from pooled-analysis support disease-free survival and overall survival benefit after fuorouracil based adjuvant therapy in stage III elderly and fit patients. In-
stead, there is disagreement regarding benefit of adding oxalplatin in elderly patients. Disease-free survival benefit has been identified in some elderly patients, however it is still not clear how to define this subset of patients. The safety profile of doublet chemotherapy is similar when comparing age < 70 and >= 70 sub-groups.
Potential benefit from adjuvant chemotherapy in older adults must be weighTed against the risks attributable to increased toxicity, reduced organ function and limited social support. Comorbidities, as competing causes of death, play an essential role in determinig the survival of elderly patients and can diminish or negate the benefit of adjuvant chemotherapy. Comprehensive geriatric assessment is recommended to define the presence or absence of frailty.