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Chemoradiotherapy for Gastrointestinal Malignancies

  • Jonathan B. WallachEmail author
  • Michael J. Nissenblatt
Living reference work entry

Abstract

There is a paucity of data from randomized controlled trials for evidence-based decision-making for older patients. Many gastrointestinal malignancies require trimodality therapy with surgery, chemotherapy, and radiotherapy, but physicians have historically undertreated older patients who may have benefitted from more aggressive approaches, leading to suboptimal outcomes. The comprehensive geriatric assessment (CGA) has been developed to stratify older adults into tiers based upon their level of fitness to receive oncologic therapy and to assess appropriate goals of care. As with all age cohorts, immunotherapy is dramatically changing survival, and stereotactic body radiotherapy (SBRT) performs very powerful, targeted treatments to a variety of sites. Treatment recommendations should be made at an interdisciplinary tumor board represented by all pertinent specialties. Shared decision-making is important to balance the benefits and risks. Prospective studies should enroll more older patients, enabling physicians to best know how to evaluate and treat this expanding cohort of the oncology population.

Keywords

Gastrointestinal cancer Geriatric Surgery Chemotherapy Radiotherapy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologySaint Peter’s University HospitalNew BrunswickUSA
  2. 2.Regional Cancer Care AssociatesEast BrunswickUSA

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