Treatment of old patients
Old patients were deemed as high risk for surgery and multimodal treatment. Surgery applied was not always standard. Old patients were excluded from multimodal studies. According to the high level of patient care in Ulm and in Wiesbaden, old patients were surgically treated with highest standards of intensive care and were not excluded from the FOGT trials by „mere age“. Thus, from the FOGT trials unique data could be presented concerning the benefit of multimodal therapy in old patients.
Why and how?:
Excellent data from Ulm and APK Wiesbaden concerning morbidity/mortality of surgical treatment in patients of all ages. „FOGT“ trials see above. Good cooperation with the department of geriatric medicine at APK Wiesbaden.
Surgical morbidity („complications“) in colon- and rectal cancer patients treated by elective surgery only did not differ between age groups according to the data of the colon- and rectal cancer group at Dept.Surgery I, Univ Ulm (>2400 patients, slide 1). Risk factors must be identified and treated.
Multimodal therapy of aged patients:
Colon cancer patients benefited from adjuvant chemotherapy with 5-FU+Folinic Acid irrespective of age (slide 2). The FOGT 1 trial is one of the very view trials to be able providing the data, as age was not an exclusion criterium, and toxicity was very low! Patients older than 70y do not benefit from FOLFOX!
Rectal cancer patients older than 70y may have no benefit of intensified adjuvant radiochemotherapy according to FOGT 2 (slide 3). They may have even a disadvantage from radiochemotherapy if older than 75 years (Fietkau). This question will be worked up scientifically.