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Z Gastroenterol 2019; 57(04): 484-490
DOI: 10.1055/a-0851-6978
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy of palliative chemotherapy in elderly patients with colorectal cancer

Palliative Chemotherapie bei alten Patienten mit kolorektalem Karzinom
Wolfram Bohle
  Klinik für allg. Innere Medizin, Gastroenterologie, Hepatologie, Infektiologie u. Pneumologie, Katharinenhospital, Klinikum Stuttgart, Germany
,
Amelie Pachlhofer
  Klinik für allg. Innere Medizin, Gastroenterologie, Hepatologie, Infektiologie u. Pneumologie, Katharinenhospital, Klinikum Stuttgart, Germany
,
Wolfram G. Zoller
  Klinik für allg. Innere Medizin, Gastroenterologie, Hepatologie, Infektiologie u. Pneumologie, Katharinenhospital, Klinikum Stuttgart, Germany
› Institutsangaben
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Publikationsverlauf

11. Oktober 2018

30. Januar 2019

Publikationsdatum:
09. April 2019 (online)

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Abstract

Background The number of old patients suffering from colorectal cancer rises. In clinical trials, old patients are underrepresented, and chemotherapy is significantly less often performed in elderly patients. We analyzed the impact of elder age for palliative chemotherapy in patients suffering from metastatic colorectal cancer, according to therapeutic drugs used, intensity of treatment performed, and therapeutic results.

Materials and methods We analyzed consecutive patients with metastatic colorectal cancer treated in palliative intention in our department. Assessed data included age (</> 75 years), sex, comorbidity, site of primary tumor, k-ras-status, site and amount of metastasis, number and kind of chemotherapeutic agents used, number of consecutive therapy lines performed, dose intensity, toxicity, time between start and end of palliative chemotherapy, and overall survival. Prognostic variables were tested in uni- and multivariate analysis.

Results Ninety-seven patients (69 < 75, 18 > 75 years) were included. Age groups were well balanced according to site of primary tumor, k-ras-mutational status, localization, and number of metastatic sites. Cardial and renal comorbidity was more frequent in elderly patients. The median number of chemotherapeutic drugs used and lines of therapy performed did not differ between age groups, except of oxaliplatin, which was significantly less often used in old patients. Median survival did not differ between age groups (23.4 vs. 23.5 months). In multivariate analysis, only left-sided primary tumor and more than 3 lines of therapy performed were prognostic positive variables.

Conclusion Old patients can profit from palliative chemotherapy to the same extent as younger ones.

Zusammenfassung

Hintergrund Alte Menschen sind in Therapiestudien unterrepräsentiert, machen im klinischen Alltag aber einen bedeutenden Anteil der Patienten aus. Wir analysierten unser Patientengut auf Unterschiede in der chemotherapeutischen Behandlung jüngerer und alter Patienten und die Auswirkungen auf das Überleben.

Methodik Ausgewertet wurden die Daten von 97 Patienten (79 < 75 Jahre, 18 > 75 Jahre) mit palliativer Chemotherapie aufgrund eines kolorektalen Karzinoms. Erfasst wurden Alter, Geschlecht, Komorbidität, Seitenlokalisation des Primärtumors, kras-Status, Metastasierungsausmaß, Art und Anzahl der eingesetzten Chemotherapeutika, Anzahl unterschiedlicher Therapielinien, Behandlungsdauer, Therapietoxizität und Gesamtüberleben.

Ergebnisse Patienten über 75 Jahre wiesen häufiger eine kardiale oder renale Komorbidität auf. Das mediane Gesamtüberleben beider Alterskollektive war gleich (23,5 vs. 23,4 Monate), ebenso die Gesamtbehandlungsdauer, die mediane Anzahl an Therapielinien und die mediane Anzahl eingesetzter unterschiedlicher Medikamente. Alte Patienten wurden jedoch signifikant seltener mit Oxaliplatin behandelt. In der Multivarianzanalyse waren nur die Seitenlokalisation des Primarius und die Anzahl der eingesetzten Therapielinien statistisch signifikant mit der Überlebenszeit assoziiert.

Schlussfolgerung Moderne Kombinationschemotherapien können auch bei alten Patienten erfolgreich eingesetzt werden.

Key words

chemotherapy - old patients - palliative therapy - colon cancer

Schlüsselwörter

Chemotherapie - alte Patienten - palliative Therapie - Kolonkarzinom
 

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