ESTRO 36 Abstract Book

S170

ESTRO 36 2017

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time intervals. The 1

group included 305 patients

undergone TME within 6 weeks, the 2

group included

1610 patients undergone TME within 7-12 weeks, and the

group included 198 patients undergone TME within 13

or more weeks after CRT, respectively.

Results

Data on 2113 patients treated between 1997 and 2016

were retrieved from the historical database of

gastrointestinal radiation oncologists joined into the

study. Recruitment in the period investigated by the study

took place as follows: 183 patients from 1997 to 2002, 550

from 2003 to 2008, and the majority, 1380, from 2009 to

2016. Five hundred and eighty two patients had stage II

(T3–4, N0) and 1531 had stage III (any T, N1–2) histological

proven invasive rectal adenocarcinoma. A CRT schedule

with one (1600 pts) or 2-drugs was administered (513 pts).

Overall, pCR were 468 (22%). Among the 2113 assessable

patients the proportion of patients achieving a pCR

increased according with time interval, as follows: 12.4%

group), 22.9% (2

group), and 30.8% (3

group)

(p<0.001, ANOVA test), respectively. The 1

group had a

pCR odds ratio of 0.47 compared to 2

group, while the

latter had a pCR odds ratio of 0.66 compared to 3

group.

Moreover, 1

group had a pCR odds ratio of 0.31 compared

to 3

group. The rate of complete response increments for

each week of waiting was 1.5% (about 0.2%/die) . At

univariate analysis, time interval (p<0.001), radiotherapy

dose (>5040 cGy; p=0.013), and clinical tumor stage

(p=0.029) were significantly correlated to pCR. The

positive impact of time interval (p<0.001) and clinical

tumor stage (p=0.038) were confirmed by multivariate

analysis, in agreement with the literature data (Table 1).

Conclusion

We confirmed on a population-level that lengthening the

interval (>13 weeks) from CRT to surgery improves the pCR

in comparison to historic data, possibly due to technical

improvement of radiotherapy such as the ability of high-

precision dose delivery and real-time knowledge of the

target volume location.

PV-0327 The effect of postoperative complications on

Quality of Life in elderly rectal cancer patients

A.M. Couwenberg

, F.S.A. De Beer

, M.P.W. Intven

, M.E.

Hamaker

, W.M.U. Van Grevenstein

, H.M. Verkooijen

UMC Utrecht, Radiotherapy, Utrecht, The Netherlands

Diakonessenhuis, Geriatrics, Utrecht, The Netherlands

UMC Utrecht, Surgery, Utrecht, The Netherlands

UMC Utrecht, Imaging Division, Utrecht, The

Netherlands

Purpose or Objective

As result of the aging population, increasing life

expectancy and increasing rectal cancer incidence, more

elderly patients will undergo treatment for rectal cancer.

Neoadjuvant (chemo)radiotherapy and surgery are

associated with considerable morbidity and mortality. In

this study we compared treatment course, postoperative

complications and quality of life (QoL) in older versus

younger rectal cancer patients.

Material and Methods

All patients within the Dutch prospective colorectal

cancer cohort with primary rectal cancer referred for

Radiotherapy at the UMC Utrecht between February 2013

and January 2016 were selected. QoL was assessed with

the EORTC-C30 questionnaire before start of neoadjuvant

treatment and at 3, 6 and 12 months afterwards. Patients

were divided into elderly (≥70 years) and non-elderly (<70

years). Differences in QoL were analyzed with generalized

estimation equations, adjusted for baseline score, and

stratified according to presence of postoperative

complications.

Results

A total of 115 elderly (33.3%) and 230 non-elde rly (66.6%)

patients were included. Compared to non-eld erly, elderly

patients were less often male (62.6% vs. 75.2%), had more

often previous abdominal surgery (40.9% vs. 30.0%) and

presence of comorbidities (80.0% vs. 59.1%). Elderly were

more likely to undergo short-course radiation with delayed

surgery and less likely to undergo chemoradiation (resp.

19.1% and 39.1% vs. 6.1% and 62.6% in non-elderly,

p<.001). Surgery was performed equally in both groups

(83.5% in elderly vs. 87.8% in non-elderly, p=.318). The

reasons for no surgical treatment, included disease

progression and poor performance status in elderly, and

disease progression or a wait-and-see policy in non-

elderly. No differences were observed in postoperative

complications between elderly and non-elderly (surgical-

and non-surgical complication rate 36,5% vs. 34,7%,

p=.780), neither when stratified for type of neoadjuvant

therapy or surgical procedure. Trends of functional QoL

domains were similar between elderly and non-elderly

during the first year after diagnosis with lowest scores at

3 and/or 6 months. In elderly, postoperative

complications had a stronger impact on physical- and role

functioning (at 6 months resp. MD -19.2 and -18.4, relative

to non-elderly with postoperative complications) (Figure

1). In a sensitivity analysis, comparing patients >80 years

with younger patients, comparable results were observed.

Conclusion

Elderly are more often treated by less invasive

treatments, which deviates from the standard treatment.

Compared with younger patients, elderly have similar

postoperative complication rates. Nevertheless, the

impact of postoperative complications on physical- and

role functioning is stronger in elderly than in younger

patients. These results suggest a need to predict the

frailest elderly patients who are at risk for postoperative

morbidity and hereby an impaired quality of life.