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Conclusions and Further Reading - Chapter 14

Chapter 14 – Treatment of Colorectal Cancer in the Senior Patient

Conclusions

Therapeutic decisions for older patients with CRC should be made in the context of a multidisciplinary team, which could include a geriatrician. All older patients should be considered for comprehensive geriatric assessment. The notion of chronological age as a factor for unfitness should be abandoned. Adjuvant and palliative chemotherapy should not be denied to patients because of age. There is a clear benefit for the adjuvant use of 5FU/LV or capecitabine monotherapy in the adjuvant setting for stage III CRC. The magnitude of benefit for the addition of oxaliplatin in patients above 70 on the other hand is questionable. For patients with metastatic disease, liver metastasectomy, if applicable, should not be discouraged, especially if there is a potential for cure. Fit older patients can benefit from palliative combination chemotherapy and biologic agents. However, the balance of toxicity/benefit must be considered. Less fit patients can be treated with lower intensity regimens like reduced-dose FOLFOX, fluoropyrimidine monotherapy or capecitabine and bevacizumab. Constant evaluation of the performance status, monitoring for toxicity and early intervention in the case of adverse events are an essential part of the management for older patients with CRC.

Further Reading

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