To describe treatment patterns and outcome for short-course preoperative radiotherapy in patients with mobile rectal cancer according to age and comorbidity.

All 914 patients, aged≥50years, with T2-T3, N0-2, M0 rectal cancer, newly diagnosed in Southern Netherlands between 2002 and 2006 were included. The influence of age, patient and tumour characteristics and type of surgery on treatment with 5×5Gy preoperative radiotherapy and survival was analysed.

Patients younger than 70years received radiotherapy less frequently if they had multiple comorbid conditions (OR=0.4), a history with previous cancer (OR=0.2) or had undergone low anterior resection (OR=0.5). Among patients aged 70years or older, men received radiotherapy more often than women (OR=2.0) and withholding radiotherapy was associated with multiple comorbid conditions (OR=0.3), low anterior resection (OR=0.3), diabetes mellitus (OR=0.5) or age above 80years (OR=0.5). Among patients≥70years old, hazard ratios for death were increased for males (HR=1.5), higher age (HR=1.06 per year of age), multiple comorbidities (HR=1.7) and pulmonary disease (HR=1.6) independently. Receiving radiotherapy had no significant influence on survival after adjustment for other prognostic variables.

Withholding short-course preoperative radiotherapy depends on age only in patients aged 70years or older. As a rule, factors that predict life expectancy, determine also the decision to withheld preoperative radiotherapy. With the exception that women receive radiotherapy less frequently as compared to men, although women survive longer.