Chemotherapy for colorectal cancer in the elderly
Chemotherapy for colorectal cancer in the elderly
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DOI：
10.3748/wjg.v21.i17.5158
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发表时间：
2015-05-07
影响因子：
4.3
通讯作者：
Kim, Jung Han
中科院分区：
文献类型：
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作者：
Kim, Jung Han
结直肠癌(CRC)是老年人癌症相关死亡的主要原因之一。然而，老年结直肠癌患者在临床试验中往往被低估，在临床实践中也往往得不到充分治疗。高龄本身不应成为阻碍老年结直肠癌患者有效治疗的唯一标准。全面的老年评估可以为癌症的最佳治疗提供最佳的指导。老年患者分期。结肠癌可以享受与年轻患者一样的5-氟尿嘧啶/亚叶酸钙或卡培他滨辅助化疗的好处，而不会大幅增加毒性。由于回溯性研究的结果相互矛盾，且缺乏随机研究提供的数据，在老年局部进展期直肠癌患者中，联合治疗应非常谨慎。老年转移性结直肠癌患者可考虑联合化疗。然而，对于虚弱或脆弱的老年患者，单一疗法或走走停停的策略可能是可取的。鉴于其更好的疗效和毒性，靶向治疗在老年转移性结直肠癌患者中的应用似乎是有希望的。治疗应根据疾病的性质、生理或功能状态以及患者的喜好进行个体化治疗。
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. 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.