Published online May 7, 2015. doi: 10.3748/wjg.v21.i17.5158
Peer-review started: November 26, 2014
First decision: February 10, 2015
Revised: March 2, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: May 7, 2015
Processing time: 168 Days and 4.5 Hours
Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the elderly. However, elderly patients with CRC tend to be under-presented in clinical trials and undertreated in clinical practice. Advanced age alone should not be the only criteria to preclude effective therapy in elderly patients with CRC. The best guide about optimal cancer treatment can be provided by comprehensive geriatric assessment. Elderly patients with stage III colon cancer can enjoy the same benefit from adjuvant chemotherapy with 5-fluorouracil/leucovorin or capecitabine as younger patients, without a substantial increase in toxicity. With conflicting results of retrospective studies and a lack of data available from randomized studies, combined modality treatment should be used with great caution in elderly patients with locally advanced rectal cancer. Combination chemotherapy can be considered for older patients with metastatic CRC. For elderly patients who are frail or vulnerable, however, monotherapy or a stop-and-go strategy may be desirable. The use of targeted therapies in older patients with metastatic CRC appears to be promising in view of their better efficacy and toxicity. Treatment should be individualized based on the nature of the disease, the physiologic or functional status, and the patient’s preference.
Core tip: Colorectal cancer (CRC) is one of the leading causes of cancer-related death in the elderly. However, elderly patients with CRC tend to be under-presented in clinical trials and undertreated in clinical practice. In older patients with CRC, advanced age alone should not be the only criteria to preclude adjuvant or palliative chemotherapy that is effective in younger patients. This review provides readers with a better understanding of the potential benefit of chemotherapy in older patients with CRC.