In this study, the International Society of Geriatric Oncology (SIOG) updated recommendations for treating elderly patients with colorectal cancer. 

Colorectal cancer is one of the most common cancers worldwide. The majority of colorectal cancer cases are diagnosed in people over 70 years old. The recommended treatment for elderly people is sometimes inadequate for specific cases. In 2013, the SIOG gathered a panel of experts who provided updated recommendations for elderly patients. These recommendations are based on different factors that can affect the treatment of elderly colorectal cancer patients. 

This study involved a group of experts in different areas who made several updates to the previous recommendations.

A geriatric assessment is recommended for each patient. This is an evaluation of the overall health and status of elderly patients before treatment. This assessment should take into account factors such as life expectancy and treatment tolerance that can affect outcomes. For example, physical weakness in patients over 75 has been associated with a 4-fold increase in the odds of surgical complications. A geriatric assessment can assist doctors and patients in the creation of a treatment plan.

A pre-surgery program should be considered before treatment to evaluate nutrition and control other existing diseases. Emergency surgery should be kept to a minimum, if possible, due to poorer recovery. Patients and families should be informed of the risks and offered other options.

For elderly patients with stage 3 cancer, combined chemotherapy is recommended. The recommended combinations are XELOX (a combination of capecitabine and oxaliplatin) or FOLFOX (a combination of 5-fluorouracil, leucovorin, and oxaliplatin). Due to an increase of treatment intolerance in elderly patients, single chemotherapy agents can also be considered. Capecitabine or 5-fluorouracil/leucovorin are recommended.

Palliative chemotherapy is a treatment that reduces pain and increases survival time without curing the disease. In fit elderly patients, combination chemotherapy, including other treatments such as bevacizumab (Avastin), may improve survival. Bevacizumab added to the chemotherapy capecitabine, for example, led to an improved time to disease progression (8.8 months) compared to capecitabine alone (5.8 months). For less fit patients smaller doses should be given.

In patients with rectal cancer waiting for surgery, radiation therapy and surgery within 2-3 days should be considered. However, waiting 6-8 weeks following radiation therapy in very old and not fit patients is an option. Another option is long course chemotherapy and radiation therapy 6-8 weeks before surgery.

If the tumor needs to decrease in size before surgery, the patient should wait 6-12 weeks following chemotherapy and radiation. Long course radiation therapy alone before surgery can be considered in patients not fit enough to receive chemotherapy. For fit patients with inoperable tumors, long course chemotherapy and radiation therapy is the recommended treatment. 

These recommendations have suggested treatment for elderly colorectal cancer patients should be individualized. The overall health and physical status of the patient should be taken into account when deciding on a treatment plan. This way treatments would be more effective with fewer complications.