Seminars in Oncology
Volume 31, Issue 2 , Pages 206-219 , April 2004

Gastrointestinal cancer in older patients

  • Peter C Enzinger

      Affiliations

    • Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
    • Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
    • Department of Medicine, Harvard Medical School, Boston, MA, USA
    • Corresponding Author InformationAddress reprint requests to Peter C. Enzinger, MD, Dana-Farber Cancer Institute, 44 Binney St, Boston, MA 02115 USA
    • ,
  • Robert J Mayer

      Affiliations

    • Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
    • Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
    • Department of Medicine, Harvard Medical School, Boston, MA, USA

References 

  1. Jemal A, Murray T, Samuels A, et al.  Cancer Statistics, 2003. CA Cancer J Clin. 2003;53:5–26
  2. Ries L, Eisner M, Kosary C, et al.  SEER Cancer Statistics Review, 1973–1999. Bethesda, MD: National Cancer Institute; 2002; Available at: http://seer.cancer.gov/csr/1973_1999/esoph.pdf Accessed July 10, 2003
  3. Vercelli M, Capocaccia R, Quaglia A, et al.  Relative survival in elderly European cancer patients (Evidence for health care inequalities). Crit Rev Oncol Hematol. 2000;35:161–179
  4. Yancik R, Ries L. Cancer in older persons. Cancer. 1994;74:1995–2003
  5. Zhang B, Fattah A, Nakama H. Characteristics and survival rate of elderly patients with colorectal cancer detected by immunochemical occult blood screening. Hepatogastroenterology. 2000;47:414–418
  6. Barrier A, Ferro L, Houry S, et al.  Rectal cancer surgery in patients more than 80 years of age. Am J Surg. 2003;185:54–57
  7. Jessup J, McGinnis L, Steele G, et al.  The National Cancer Data Base. Report on colon cancer. Cancer. 1996;78:918–926
  8. Coburn M, Pricolo V, Soderberg C. Factors affecting prognosis and management of carcinoma of the colon and rectum in patients more than eighty years of age. J Am Coll Surg. 1994;179:65–69
  9. Arai T, Takubo K, Sawabe M, et al.  Pathologic characteristics of colorectal cancer in the elderly (A retrospective study of 947 surgical cases). J Clin Gastroenterol. 2000;31:67–72
  10. Paksoy M, Ipek T, Colak T, et al.  Influence of age on prognosis and management of patients with colorectal carcinoma. Eur J Surg. 1999;165:55–59
  11. Mulcahy H, Patchett S, Daly L, et al.  Prognosis of elderly patients with large bowel cancer. Br J Surg. 1994;81:736–738
  12. Damhuis R, Wereldsma J, Wiggers T. The influence of age on resection rates and postoperative mortality in 6,457 patients with colorectal cancer. Int J Colorectal Dis. 1996;11:45–48
  13. Adloff M, Ollier J, Schloegel M, et al.  Colorectal cancer in patients over the age of 80 years. Ann Chir. 1993;47:492–496
  14. Yancik R, Wesley M, Ries L, et al.  Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients. Cancer. 1998;82:2123–2134
  15. Irvin T. Prognosis of colorectal cancer in the elderly. Br J Cancer. 1988;75:419–421
  16. Curless R, French J, Williams G, et al.  Comparison of gastrointestinal symptoms in colorectal carcinoma patients and community controls with respect to age. Gut. 1994;35:1267–1270
  17. Burt R. Hereditary aspects of the polyposis syndromes. Hematol Oncol Ann. 1994;2:163–170
  18. Burke W, Petersen G, Lynch P, et al.  Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA. 1997;277:915–919
  19. Thun M, Namboodiri M, Heath C. Aspirin use and reduced risk of fatal colon cancer. N Engl J Med. 1991;325:1593–1596
  20. Giovannucci E, Rimm E, Stampfer M, et al.  Aspirin use and the risk for colorectal cancer and adenoma in male health professionals. Ann Intern Med. 1994;121:241–246
  21. Giovannucci E, Egan K, Hunter D, et al.  Aspirin and the risk of colorectal cancer in women. N Engl J Med. 1995;333:609–614
  22. Giovannucci E, Stampfer M, Colditz G, et al.  Multivitamin use, folate, and colon cancer in women in the Nurses’ Health Study. Ann Intern Med. 1998;129:517–524
  23. Calle E, Miracle-McMahill H, Thun M, et al.  Estrogen replacement therapy and the risk of fatal colon cancer in a prospective cohort of postmenopausal women. J Natl Cancer Inst. 1995;87:517–523
  24. Grodstein F, Martinez E, Platz E, et al.  Postmenopausal hormone use and risk for colorectal cancer and adenoma. Ann Intern Med. 1998;128:705–712
  25. Rossouw J, Anderson G, Prentice R, et al.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women (Principal results from the Women’s Health Initiative randomized controlled trial). JAMA. 2002;288:321–333
  26. Williams A, Balasooriya B, Day D. Polyps and cancer of the large bowel (A necropsy study in Liverpool). Gut. 1982;23:835–842
  27. Muller A, Sonnenberg A. Prevention of colorectal cancer by flexible endoscopy and polypectomy. A case-control study of 32,702 veterans. Ann Intern Med. 1995;123:904–910
  28. Winawer S, Zauber A, Ho M, et al.  Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med. 1993;329:1977–1981
  29. Fearon E, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61:759–767
  30. Kronborg O, Fenger C, Olsen J, et al.  Randomized study of screening for colorectal cancer with faecal-occult-blood test. Lancet. 1996;348:1467–1471
  31. Hardcastle J, Chamberlain J, Robinson M, et al.  Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet. 1996;348:1472–1477
  32. Mandel J, Church T, Bond J, et al.  The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343:1603–1607
  33. Selby J, Friedman G, Quesenberry C, et al.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653–657
  34. Newcomb P, Norfleet R, Storer B, et al.  Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst. 1992;84:1572–1575
  35. Gatto N, Frucht H, Sundararajan V, et al.  Risk of perforation after colonoscopy and sigmoidoscopy (A population-based study). J Natl Cancer Inst. 2003;95:230–236
  36. US Preventative Services Task Force . Guide to Clinical Preventive Services. (ed 2). Baltimore, MD: Williams & Wilkins; 1996;
  37. Winawer S, Fletcher R, Miller L, et al.  Colorectal cancer screening (Clinical guidelines and rationale). Gastroenterology. 1997;112:594–642
  38. Byers T, Levin B, Rothenberger D, et al.  American Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer: Update 1997. American Cancer Society Detection and Treatment Advisory Group on Colorectal Cancer. CA Cancer J Clin. 1997;47:154–160
  39. Levin B, Barthel J, David D, et al.  NCCN colorectal cancer screening practice guidelines. Oncology. 1999;13:152–179
  40. Vernon S. Participation in colorectal cancer screening (A review). J Natl Cancer Inst. 1997;89:1406–1422
  41. Sirovich B, Schwartz L, Woloshin S. Screening men for prostate and colorectal cancer in the United States. Does practice reflect evidence?. JAMA. 2003;289:1415–1420
  42. Bureau USC . Vital Statistics. 2001; Available at: http://www.census.gov/prod/2001pubs/statab/sec02.pdf Accessed July 8, 2003
  43. Lewis A, Khoury G. Resection for colorectal cancer in the very old (Are the risks too high?). BMJ. 1988;296:459–461
  44. Whittle J, Steinberg E, Anderson G, et al.  Results of colectomy in elderly patients with colon cancer, based on Medicare claims data. Am J Surg. 1992;163:572–576
  45. Arveux I, Boutron M, El Mrini T, et al.  Colon cancer in the elderly (Evidence for major improvements in health care and survival). Br J Cancer. 1997;76:963–967
  46. Catena F, Pasqualini E, Tonini V, et al.  Emergency surgery for patients with colorectal cancer over 90 years of age. Hepatogastroenterology. 2002;49:1538–1539
  47. Moertel C, Fleming T, Macdonald J, et al.  Intergroup study of fluorouracil plus levamisole as adjuvant therapy for stage II/Dukes’ B2 colon cancer. J Clin Oncol. 1995;13:2936–2943
  48. Sundarajan V, Grann V, Jacobson J, et al.  Variations in the use of adjuvant chemotherapy for node-positive colon cancer in the elderly (A population-based study). Cancer J. 2001;7:213–218
  49. Schrag D, Cramer L, Bach P, et al.  Age and adjuvant chemotherapy use after surgery for stage III colon cancer. J Natl Cancer Inst. 2001;93:850–857
  50. Ayanian JZ, Zaslavsky AM, Fuchs CS, et al.  Use of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort. J Clin Oncol. 2003;21:1293–1300
  51. Ashele C, Guglielmi A, Tixi L, et al.  Adjuvant treatment of colorectal cancer in the elderly. Cancer Control. 1995;2:36–38
  52. Mandelblatt J, Yabroff K, Kerner J. Equitable access to cancer services (A review of barriers to quality care). Cancer. 1999;86:2378–2390
  53. Sargent D, Goldberg R, Jacobson J, et al.  A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med. 2001;345:1091–1097
  54. Popescu R, Norman A, Ross P, et al.  Adjuvant or palliative chemotherapy for colorectal cancer in patients 70 years or older. J Clin Oncol. 1999;17:2412–2418
  55. Gastrointestinal Tumor Study Group . Prolongation of the disease-free interval in surgically treated rectal carcinoma. N Engl J Med. 1985;312:1465–1472
  56. National Institute of Health Consensus Conference . Adjuvant therapy for patients with colon and rectal cancer. JAMA. 1990;264:1444–1450
  57. Newcomb P, Carbone P. Cancer treatment and age (Patient perspectives). J Natl Cancer Inst. 1993;85:1580–1584
  58. Schrag D, Gelfand S, Bach P, et al.  Who gets adjuvant treatment for stage II and III rectal cancer? Insight from the Surveillance, Epidemiology, and End Results-Medicare. J Clin Oncol. 2001;19:3712–3718
  59. Neugut A, Fleischauer A, Sundarajan V, et al.  Use of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly (A population-based study). J Clin Oncol. 2002;20:2643–2650
  60. Ooi B, Tjandra J, Green M. Morbidities of adjuvant chemotherapy and radiotherapy for resectable rectal cancer (An overview). Dis Colon Rectum. 1999;42:403–418
  61. Farniok K, Levitt S. The role of radiation therapy in the treatment of colorectal cancer. Implications for the older patient. Cancer. 1994;74:2154–2159
  62. Benson A, Desch C, Flynn P, et al.  2000 update of American Society of Clinical Oncology colorectal cancer surveillance guidelines. J Clin Oncol. 2000;18:3586–3588
  63. Knopf K, Warren J, Feuer E, et al.  Bowel surveillance patterns after a diagnosis of colorectal cancer in Medicare beneficiaries. Gastrointest Endosc. 2001;54:563–571
  64. Fong Y, Blumgart L, Fortner J, et al.  Pancreatic or liver resection for malignancy is safe and effective for the elderly. Ann Surg. 1995;222:426–434
  65. McKenna R. Thoracoscopic lobectomy with mediastinal sampling in 80-year-old patients. Chest. 1994;106:1902–1904
  66. Sundararajan V, Grann V, Neugut A. Population based variation in the use of chemotherapy for colorectal cancer in the elderly. Proc Am Soc Clin Oncol. 1999;18:A1598; (abstr)
  67. Chiara S, Nobile M, Vincenti M, et al.  Advanced colorectal cancer in the elderly (results of consecutive trials with 5-fluorouracil-based chemotherapy). Cancer Chemother Pharmacol. 1998;42:336–340
  68. Weinerman B, Rayner H, Venne A, et al.  Increased incidence and severity of stomatitis (S) in women treated with 5-fluorouracil (F) and leucovorin (L). Proc Am Soc Clin Oncol. 1998;17:A1176; (abstr)
  69. Magne N, Francois E, Broisin L, et al.  Palliative 5-fluorouracil-based chemotherapy for advanced colorectal cancer in the elderly (Results of a 10-year experience). Am J Clin Oncol. 2002;25:126–130
  70. Knight R, Miller L, Elfring G, et al.  Evaluation of age, gender, performance status (PS), and organ dysfunction as predictors of toxicity with first-line irinotecan (C), fluorouracil (F), leucovorin (L) therapy of metastatic colorectal cancer (MCRC). Proc Am Soc Clin Oncol. 2001;20:A534; (abstr)
  71. Daniele B, Rosati G, Tambaro R, et al.  First-line chemotherapy with fluorouracil and folinic acid for advanced colorectal cancer in elderly patients (A phase II study). J Clin Gastroenterol. 2003;36:228–233
  72. Mattioli R, Lippe P, Recchia F, et al.  Advanced colorectal cancer in elderly patients (Tolerance and efficacy of leucovorin and fluorouracil bolus plus continuous infusion). Anticancer Res. 2001;21:489–492
  73. Escudero P, Verge V, Feliu J, et al.  A study of capecitabine in elderly patients as first line treatment in advanced or metastatic colorectal cancer. Proc Am Soc Clin Oncol. 2003;22:A3114; (abstr)
  74. Schaaf L, Ichhpurani N, Elfring G, et al.  Influence of age on the pharmacokinetics of irinotecan (CPT-11) and its metabolites, SN-38 and SN-38 glucuronide (SN-38G), in patients with previously treated colorectal cancer. Proc Am Soc Clin Oncol. 1997;16:A708; (abstr)
  75. Pazdur R, Zinner R, Rothenberg M, et al.  Age as a risk factor in irinotecan (CPT-11) treatment of 5-FU refractory colorectal cancer. Proc Am Soc Clin Oncol. 1997;16:A921; (abstr)
  76. Pitot H. US pivotal studies of irinotecan in colorectal carcinoma. Oncology. 1998;12:48–53
  77. Saltz L, Cox J, Blanke C, et al.  Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. N Engl J Med. 2000;343:905–914
  78. Cunningham D, Pyrhoenen S, James R, et al.  Randomized trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet. 1998;352:1413–1418
  79. Fuchs C, Moore M, Harker G, et al.  Phase III comparison of two irinotecan dosing regimens in second-line therapy of metastatic colorectal cancer. J Clin Oncol. 2003;21:807–814
  80. Sastre J, Marcuello E, Massuti B, et al.  CPT-11 + 48h 5-FU continuous infusion (CI) as first line chemotherapy for elderly patients (pts) with metastatic colorectal cancer (MCRC). Preliminary results of a Spanish digestive (TTD) group study. Proc Am Soc Clin Oncol. 2003;22:A1329; (abstr)
  81. Bollina R, Beretta G, Toniolo D, et al.  Capecitabine (C) and irinotecan (I) (CAPIRI): A good combination in elderly patients (pts) with advanced colorectal cancer (ACRC) as first line chemotherapy (CT). Preliminary results of a phase II trial. Proc Am Soc Clin Oncol. 2003;22:A1332; (abstr)
  82. Berretta M, Buonadonna A, Rupolo M, et al.  Comparison between elderly and non-elderly patients (PTS), of efficacy and tolerabilitiy of FOLFOX2 schedule in advanced colorectal cancer (COL). Proc Am Soc Clin Oncol. 2001;20:A2195; (abstr)
  83. Mattioli R, Recchia F, Lippe P, et al.  Bi-fractionated “FOLFOX” as first-line chemotherapy (CT) in elderly patients with metastatic colorectal cancer. Proc Am Soc Clin Oncol. 2003;22:A1411; (abstr)
  84. Carreca I, Comella P, Maiorino L, et al.  Oral capecitabine plus oxaliplatin (XELOX regimen) in elderly patients with advanced colorectal carcinoma (ACC). Southern Italy Cooperative Oncology Group (SICOG 0108) phase II study. Proc Am Soc Clin Oncol. 2003;22:A2939; (abstr)
  85. Bollina R, Toniolo D, Belloni P, et al.  Oxaliplatin (LOHP) and irinotecan (CPT-11)-OXIRI (Phase I/II study in 5-FU (F) refractory advanced colorectal cancer (ACRC) elderly patients (pts), a second line treatment). Proc Am Soc Clin Oncol. 2001;20:A1625; (abstr)
  86. Nieman J, Holmes F. Accuracy of diagnosis of pancreatic cancer decreases with increasing age. J Am Geriatr Soc. 1989;37:97–100
  87. Jacobson S, Alberts S, O’Connell M. Pancreatic cancer in the older patient. Oncology (Huntingt). 2001;15:926–932
  88. Spencer M, Sarr M, Nagorney D. Radical pancreatectomy for pancreatic cancer in the elderly. Is it safe and justified?. Ann Surg. 1990;212:140–143
  89. Gastrointestinal Tumor Study Group . Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120:899–903
  90. Gastrointestinal Tumor Study Group . Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Cancer. 1987;59:2006–2010
  91. Burris H, Moore M, Anderson J, et al.  Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer (A randomized trial). J Clin Oncol. 1997;15:2403–2413
  92. Pisani P, Parkin D, Bray F, et al.  Estimates of the worldwide mortality from 25 cancers in 1990. Int J Cancer. 1999;83:18–29 [erratum appears in Int J Cancer 1999;83:870–873)
  93. Piso P, Bektas H, Werner U, et al.  Comparison between treatment results for gastric cancer in younger and elderly patients. Zentralbl Chir. 2002;127:270–274
  94. Hanazaki K, Wakabayashi M, Sodeyama H, et al.  Surgery for gastric cancer in patients older than 80 years of age. Hepatogastroenterology. 1998;45:268–275
  95. Kubota H, Kotoh T, Dhar D, et al.  Gastric resection in the aged (≥ 80 years) with gastric carcinoma (A multivariate analysis of prognostic factors). Aust N Z J Surg. 2000;70:254–257
  96. Wanebo H, Kennedy B, Chmiel J, et al.  Cancer of the stomach. A patient care study by the American College of Surgeons. Ann Surg. 1993;218:583–592
  97. Siewert J, Bottcher K, Stein H, et al.  Relevant prognostic factors in gastric cancer (Ten-year results of the German Gastric Cancer Study). Ann Surg. 1998;228:449–461
  98. Schwarz R, Karpeh M, Brennan M. Factors predicting hospitalization after operative treatment for gastric carcinoma in patients older than 70 years. J Am Coll Surg. 1997;184:9–15
  99. Ruiz E, Quispe D, Celis J, et al.  Total gastrectomy for gastric cancer in patients over 70 years old. Rev Gastroenterol Peru. 2001;21:205–211
  100. Wu C, Lo S, Shen K, et al.  Surgical mortality, survival, and quality of life after resection for gastric cancer in the elderly. World J Surg. 2000;24:465–472
  101. Shelley MRG, Maughan T, Court J, et al.  Patient’s age correlates with plasma and renal clearance of cisplatin (CDDP). Proc Am Soc Clin Oncol. 1999;18:A877; (abstr)
  102. Lichtman S, Egorin M, Rosner G, et al.  Clinical pharmacology of paclitaxel in relation to patient age (CALGB 9762). Proc Am Soc Clin Oncol. 1999;18:A732; (abstr)
  103. Devesa S, Blot W, Fraumeni J. Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer. 1998;83:2049–2053
  104. Johansson J, Walther B. Clinical outcome and long-term survival rates after esophagectomy are not determined by age over 70 years. J Gastrointest Surg. 2000;4:55–62
  105. Kinugasa S, Tachibana M, Yoshimura H, et al.  Esophageal resection in elderly esophageal carcinoma patients (Improvement in postoperative complications). Ann Thorac Surg. 2001;71:414–418
  106. Sabel M, Smith J, Nava H, et al.  Esophageal resection for carcinoma in patients older than 70 years. Ann Surg Oncol. 2002;9:210–214
  107. Naunheim K, Hanosh J, Zwischenberger J, et al.  Esophagectomy in the septuagenarian. Ann Thorac Surg. 1993;56:880–883
  108. Ellis F, Williamson W, Heatley G. Cancer of the esophagus and cardia (Does age influence treatment selection and surgical outcomes?). J Am Coll Surg. 1998;187:345–351
  109. Thomas P, Doddoli C, Neville P, et al.  Esophageal cancer resection in the elderly. Eur J Cardiothorac Surg. 1996;10:941–946
  110. Adam D, Craig S, Sang C, et al.  Esophagectomy for carcinoma in the octogenarian. Ann Thorac Surg. 1996;61:190–194
  111. Jougon J, Ballester M, Duffy J, et al.  Esophagectomy for cancer in the patient aged 70 years and older. Ann Thorac Surg. 1997;63:1423–1427
  112. Alexiou C, Beggs D, Salama F, et al.  Surgery for esophageal cancer in elderly patients (The view from Nottingham). J Thorac Cardiovasc Surg. 1998;116:545–553
  113. Dalrymple-Hay M, Evans K, Lea R. Surgery for oesophageal carcinoma in the elderly. Acta Chir Hung. 1999;38:27–29
  114. Fang W, Igaki H, Tachimori Y, et al.  Three-field lymph node dissection for esophageal cancer in elderly patients over 70 years of age. Ann Thorac Surg. 2001;72:867–871
  115. Bonavina L, Incarbone R, Saino G, et al.  Esophagectomy for carcinoma (Impact of age on clinical results and survival). Chir Ital. 2002;54:587–590
  116. Herskovic A, Martz K, Al-Sarraf M, et al.  Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992;326:1593–1598
  117. Al-Sarraf M, Martz K, Herskovic A, et al.  Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer (An Intergroup study). J Clin Oncol. 1997;15:277–284
  118. Othman E, Ummadi S, Bundy B, et al.  Chemoradiation for elderly patients with esophageal cancer (EC). Proc Am Soc Clin Oncol. 2003;22:A1487; (abstr)
  119. Anderson S, Hummer A, Minsky B, et al.  Chemoradiation in geriatric patients with esophageal cancer is feasible and well tolerated. Proc Am Soc Clin Oncol. 2002;21:A1485; (abstr)
  120. Chun H, Puccio C, Mittelman A. Weekly docetaxel and continuous infusion (CI) 5-fluorouracil (5-FU) in elderly patients (pts) with cancer of the stomach and distal esophagus. Proc Am Soc Clin Oncol. 2001;20:A645; (abstr)
  121. Poon R, Fan S, Lo C, et al.  Hepatocellular carcinoma in the elderly (Results of surgical and nonsurgical management). Am J Gastroenterol. 1999;94:2460–2466
  122. Takenaka K, Shimada M, Higashi H, et al.  Liver resection for hepatocellular carcinoma in the elderly. Arch Surg. 1994;129:846–850
  123. Hoshida Y, Ikeda K, Saito S, et al.  The efficacy and prognosis of transcatheter chemoembolization for hepatocellular carcinoma in the elderly. Nippon Shokakibyo Gakkai Zasshi. 1999;96:142–146
  124. Lui W, Chau G, Wu C. Surgical resection of hepatocellular carcinoma in elderly cirrhotic patients. Hepatogastroenterology. 1999;46:640–645
  125. Chiappa A, Zbar A, Biella F, et al.  Validity of hepatic resection for cancer in the elderly. Ann Ital Chir. 2002;73:397–401
  126. Onoyama H, Ajiki T, Takada M, et al.  Does radical resection improve the survival in patients with carcinoma of the gallbladder who are 75 years and older?. World J Surg. 2002;26:1315–1318
  127. Ryan D, Compton C, Mayer R. Carcinoma of the anal canal. N Engl J Med. 2000;342:792–800
  128. Flam M, John M, Pajak T, et al.  Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal (Results of a phase III randomized Intergroup study). J Clin Oncol. 1996;14:2527–2539
  129. Bartelink H, Roelofsen F, Eschwege F, et al.  Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer (Results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups). J Clin Oncol. 1997;15:2040–2049
  130. Allal A, Mermillod B, Roth A, et al.  Impact of clinical and therapeutic factors on major late complications after radiotherapy with or without concomitant chemotherapy for anal carcinoma. Int J Radiat Oncol Biol Phys. 1997;39:1099–1105
  131. Trimble E, Carter C, Cain D, et al.  Representation of older patients in cancer treatment trials. Cancer. 1994;74:2208–2214
  132. Yancik R. Cancer burden in the aged (An epidemiologic and demographic overview). Cancer. 1997;80:1273–1283
  133. Unger J, Hutchins L, Crowley J, et al.  Southwest Oncology Group (SWOG) accrual by sex, race, and age, compared to US population rates. Proc Am Soc Clin Oncol. 1998;17:A1596; (abstr)
  134. Talarico L, Chen G, Pazdur R. Elderly patients in trials for cancer drug registration (A 7-year experience by the Food and Drug Administration (FDA)). Proc Am Soc Clin Oncol. 2003;22:A2928; (abstr)
  135. Lewis J, Kilgore M, Goldman D, et al.  Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–1389
  136. Klabunde C, Springer B, Butler B, et al.  Factors influencing enrollment in clinical trials for cancer treatment. South Med J. 1999;92:1189–1193
  137. Yee K, Peter JL, Pho L, et al.  Enrollment of older patients in cancer treatment trials in Canada (Why is age a barrier?). J Clin Oncol. 2003;21:1618–1623

PII: S0093-7754(03)00669-9

doi: 10.1053/j.seminoncol.2003.12.031

Seminars in Oncology
Volume 31, Issue 2 , Pages 206-219 , April 2004

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