Interventional Procedures for Metastatic Colorectal Cancer Not Affected by Comorbidities, Older Age
Older age or a higher rate of comorbidities with age do not affect survival in metastatic colorectal cancer when patients receive radiofrequency ablation (RFA), high-dose-rate brachytherapy (HDR-BT), or Y90-radioembolization (Y90-RE), according to a study published in BMC Cancer.
An institutional data base was searched for all patients with mCRC receiving at least one RFA, HDR-BT or Y90 radioembolization between 2006 and 2010. Patients with complete patient history records and at least one follow up visit were included in this study for a total of 266 patients.
Within 12 months after diagnosis of the primary tumor, 196 patients (73.7%) had synchronous metastases. The majority of patients presented with hepatic metastases (n = 251, 94.4%), with further sites of dissemination including lung (n = 77, 28.4%), lymphatic (n = 44, 16.5%), osseous (n = 10, 3.8%), or other metastases (n = 22, 8.3%).
Most of the patients failed at least one or two lines of chemotherapy (n = 79, 29.7% an n = 160, 60.2%, respectively), and 169 patients (63.5%) received EGFR or VEGF inhibiting therapy. Surgery for the primary tumor had been performed in 263 patients (98.9%), resection of hepatic metastases in 91 patients (34.2%), and resection of lung/other metastases in 34 patients (12.8%).\
Charlson Comorbidity Index (CCI) was used to measure comorbidity and age-adjusted Charlson Index (CACI) excluding mCRC as the index disease. Kaplan-Meier survival analysis and Cox regression were used for statistical analysis.
The overall median survival was 14 months. Age ≥ 70 years did not influence survival after local therapies. Multivariate analyses showed that CCI or CACI did not affect the patients prognoses. The only comorbidity that negatively impacted outcome after local therapy was moderate or severe renal insufficiency (n = 12; P = 0.005).
“Our study has demonstrated that older age or a higher rate of comorbidities with age (CCI and CACI) do not influence survival in metastatic colorectal cancer when patients are selected for local or loco-regional ablation by RFA, HDR-BT or Y90 radioembolization,” the authors concluded.
Seidensticker R, Damm R, Enge J, et al. Local ablation or radioembolization of colorectal cancer metastases: comorbidities or older age do not affect overall survival. BMC Cancer. 2018;18(1):882. doi: 10.1186/s12885-018-4784-9.