Gastrointestinal Cancers

Tumors of the gastrointestinal tract commonly appear in subjects over 70 years old. The adjuvant treatment of colon cancer in patients of more than 70 years with fluoropyrimidines has the same benefits compared with the younger patients. The addition of oxaliplatin after age of 70 or 75 has to be evaluated according to the patient. Some studies show no benefit in the use of oxaliplatin as an adjuvant among older patients [31].

In metastatic patients, the chemotherapy with endovenous fluoropyrimidine is better tolerated than capecitabine. Oxaliplatin may be added to endovenous fluoro- pyridine. The risk of hematologic toxicities is higher among older colorectal cancer patients. Bevacizumab or cetuximab may be associated to the chemotherapy [32, 33]. Some studies have demonstrated a higher risk of thromboembolic disease in older patients using bevacizumab. There is currently not a consensus on the better treatment in rectal cancer in older patients. It seems that perioperative treatment, neoadjuvant radio chemotherapy and adjuvant chemotherapy may be indicated with a decreased risk of disease recurrence. In some studies this treatment was associated to a higher risk of death by other causes [34, 35].

The most prevalent primary cancer in the liver is hepatocellular carcinoma (HCC) and it is the fifth cause of cancer and the third cause of death by cancer in the world. Surgery, transplantation, TACE (transarterial chemoembolization), percutaneous ablation are the most common treatments. In patients over 70 years, HCC appears in hepatitis C or B patients, in non-alcoholic fatty liver disease or in subjects without any previous liver disease. These patients are commonly treated by palliative methods instead of surgical resection. However, a recent meta-analysis did not show differences in survival after 3 years of treatment compared to younger patients [36].

Biliary tract cancers (BTC) include gallbladder cancer and intrahepatic, extrahepatic or perihilar biliary duct cancer and are one of the less common cancer of the digestive system. The higher incidence of this cancer occur commonly in patients with more than 70 years and treatment of these cancers lack studies, probably due to the short incidence. BTC older patients were mostly associated with no surgery or chemotherapy treatment [37] . Studies compared surgery in stage I or II and showed no difference on survival. Chemotherapy was associated with an increased survival compared to best supportive care. Monotherapy with gemcitabine may be better supported than the association of gemcitabine to cisplatin.

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