TITLE Adjuvant chemotherapy for stage III colon cancer in patients older than 75 years.
BACKGROUND In Norway, a chronological age limit of 80 years for receiving adjuvant chemotherapy after resection of stage III colon cancer is suggested in the national guidelines. In the United States, nearly 40 % of the 80- year old patients receive adjuvant chemotherapy. The prevalence of colon cancer is increasing, especially in elderly people.
OBJECTIVE To study the literature concerning the problem of whether to treat older patients with stage III colon cancer with adjuvant chemotherapy.
METHODS A non-systematic literature search for articles in the Pubmed database concerning colon cancer, adjuvant treatment and elderly was conducted. Treatment guidelines were searched in BMJ, UpToDate, the Cochrane database, and in the newest guidelines for treatment of colorectal cancer in Norway. Individual patient cases from a prospective observational cohort study of patients 70 years and older operated for colorectal cancer in Norway were used as clinical examples.
RESULTS Many articles, both reviews and original articles, were of interest. Studies show that a minority of elderly patients are offered adjuvant chemotherapy. A general problem is that elderly patients are underrepresented in clinical trials. Many studies have shown that selected elderly have the same survival benefit as younger patients, and acceptable toxicity. Other studies suggest that the benefit of adjuvant chemotherapy decreases with increasing age.
CONCLUSION Studies show that selected elderly patients probably have the same benefit of adjuvant chemotherapy as younger patients, but information about effect and toxicity in the elderly is lacking. The heterogeneity of the elderly population is substantial, and the remaining life expectancy varies among individuals with the same chronological age. An individual assessment of each elderly patient, and not their chronological age, should be the determining factor of the treatment decision.