Abstract Introduction Colorectal cancer (CRC) is one of the most common malig- nant tumors in the world and, in Western Europe, is the second cause of cancer death. The incidence increases with increasing age. Currently, the majority (about 70%) of colon and rectum tumors arise in patients aged 65 and over, > 50% of the cases occur in subjects aged ≥ 70 years. Improvements in public health, nutrition, and the prevention and treatment measures have prolonged the life of elderly individuals. The average life expectancy of a 70-year-old man can be prolonged 10 years and of a 70-year-old woman 15 years. As a result, there will be an increase in the prevalence of CRC in elderly patients in the coming decades. But the elderly often have some comorbid problems, and their clinical, pathologic characteris- tics are different from young patients, so providing optimal care for older patients with CRC is a highly relevant issue. It is important to collect the most data to achieve a substantial improvement in the care of CRC in these patients. Currently, most published studies include very few data about elderly patients; such data are useful but have unavoidable bias. Most important studies often do not included subjects aged ≥ 75 years. Population-based studies, record- ing all cases diagnosed in a well-defined population, represent the best way to assess improvements in the management and prognosis of CRC in the elderly. 1 Elderly patients with cancer are a very heterogeneous popula- tion; thus, treatment decisions must be individualized. Therefore, a geriatric assessment devised to predict functional outcomes in older patients will need to include measures including an evaluation of functional status, serious comorbidity, memory impairment, nutri- tion, social support, emotional state, and polypharmacy. 2 The use of comprehensive geriatric assessment (CGA) will help to identify more precisely patients who are fit compared with those who are vulnerable or frail, when deciding on chemotherapeutic treatment. The CGA scale is an instrument that consists of demographic characteristics, physical performance, and disability indices, and depression and cognitive status as measured by activities of daily liv- ing (ADL), instrumental activities of daily living (IADL), geriatric depression scale (GDS), and mini–mental state (MMS). 3 The CGA was evaluated in elderly patients with different forms of cancer; although the treatment options for CRC might account for dif- ferent relationships between comorbidity and disability, a specific instrument for this group of patients is not yet available. The CGA remains the more validated and sensitive instrument in classifying patients as fit compared to vulnerable or frail. Colorectal Cancer Treatment in Elderly Patients: An Update on Recent Clinical Studies Federica Merlin, Tiziana Prochilo, Luca Tondulli, Basem Kildani, Giordano Domenico Beretta Colorectal cancer (CRC) is one of the most common cancers in the Western world, with > 500,000 new cases diag- nosed each year. One of the strongest risk factors for colon cancer is age. Physicians and their older patients commonly face the dilemma of whether to give/receive systemic chemotherapy for CRC. Evidence supports similar survival ben- efits with adjuvant and palliative chemotherapy in elderly patients compared with younger age groups. Data on treat- ment-related side effects did not reveal a different toxicity profile for elderly patients.The safety and efficacy of systemic chemotherapy in fit older patients were proven, and this group of patients could be enrolled in clinical trials. Conversely, frail older patients are more likely to suffer adverse outcomes when faced with stressors and might not benefit from chemotherapy. Despite a growing body of data, a great deal of work is still needed to establish optimal strategies to care for patients diagnosed with cancer later in life. There is a paucity of reports published in the literature because of the difficulty in routinely collecting such data. We report an overview of recent studies (clinical trials, pooled analysis, and population studies) to provide more information and to identify new and better treatment options. Clinical Colorectal Cancer, Vol. 7, No. 6, 357-363, 2008; DOI: 10.3816/CCC.2008.n.047 Keywords: Adjuvant/metastatic chemotherapy, FOLFOX, Quality of life, Rectal cancer Electronic forwarding or copying is a violation of US and International Copyright Laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1533-0028, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA 978-750-8400. Comprehensive Review Clinical Colorectal Cancer November 2008 • 357 U.O.Oncologia Medica, Ospedale Sant’Orsola Fatebenefratelli,via Vittorio Emanuele II, Brescia, Italy Submitted: Mar 13, 2008; Revised: May 26, 2008; Accepted: Jul 24, 2008 Address for correspondence: Giordano Domenico Beretta, MD, U.O. Oncologia Medica, Ospedale Sant’Orsola, FBF, via Vittorio Emanuele II, 25122 Brescia, Italy Fax: 39-30-297-1223; e-mail: gdberetta@fatebenefratelli.it