Preoperative chemoradiotherapy has been established as a standard treatment for locally advanced rectal cancer. It is unclear whether preoperative chemoradiotherapy is truly beneficial in the elderly patients. Our aim was to assess the impact of age on the treatment tolerance and clinical outcomes.

We retrospectively analyzed 160 consecutive patients with clinical stage T3–4, and/or lymph node positive tumors who received preoperative chemoradiotherapy from May 2003 to December 2010 at a single hospital. Treatment tolerance and outcomes were compared between patients ≥70 years (N = 56) and <70 years (N = 104).

There was no disparity in the achievement of prescribed radiation dose and dose reduction of chemotherapy between two groups. Pathologic complete response rate (15.6% vs. 16.0%) and sphincter preservation rate (91.1% vs. 95.0%; P = 0.459) were not significantly different. The 3-year disease-free survival of older vs. younger patients was 77.8% vs. 92.3% and 5-year disease-free survival was 60.0% vs. 78.6%, respectively (P = 0.023). In multivariable analysis, age was significantly associated with disease-free survival (P = 0.033) but comorbidities were not (P = 0.092). However, both age (hazard ratio, 2.331; P = 0.028) and comorbidities (hazard ratio, 2.772; P = 0.031) were significantly associated with overall survival as well as clinical stage. Anemia was the only adverse effect more prominent in older patients.

Older patients showed non-inferior compliance and equivalent pathologic complete response rates without an increased incidence of treatment complications with preoperative chemoradiotherapy. More comprehensive consideration than age alone is warranted in the decision of applying preoperative chemoradiotherapy to elderly patients with rectal cancer.