流行病学数据表明，新诊断的直肠癌患者中超过50％年龄超过70岁，未来几十年这一数字还将上升。对于老年和虚弱的直肠癌患者来说，治疗决策是具有挑战性的，因为这组患者缺乏标准化的治疗指导方针。外科医生通常认为，年龄和合并症的增多会导致手术并发症和术后死亡的风险增加，因此老年和虚弱的直肠癌患者常常被认为不适合接受根治手术。此外，这些患者往往根本没有接受任何治疗，导致局部和/或全身疾病进展，伴随着相关症状和生活质量的受损。最近，针对年轻健康的早期直肠癌患者的随机试验数据表明，可以安全地使用外部束(化疗)放疗(EBRT)后通过联系式X线内照射(CTB)或高剂量内照射治疗( HDR-BT)的内腔放射治疗模式，实现放射治疗剂量的逐渐升高。然而，在老年和虚弱患者中测试这种治疗理念的前瞻性研究仍然有限。因此，本文综述了老年和虚弱直肠癌患者流行病学和管理的现有证据，并总结了放射治疗剂量逐渐升高以实现原发肿瘤的长期局部控制、预防与疾病相关的并发症、改善生活质量甚至器官保留的潜力。同时，本文还探讨了未来的前景和未解决的问题。 版权所有©2022 Elsevier Ltd.。

Epidemiological data indicate that more than 50 % of patients with newly-diagnosed rectal cancer are older than 70 years, with rising numbers expected over the next decades. Treatment decision-making is challenging in elderly and frail patients with rectal cancer, whereas standardized treatment guidelines for this patient cohort are lacking. Elderly and frail rectal cancer patients are often considered by surgeons as unfit to undergo radical surgery as the risk of surgical complications and postoperative mortality rises with increasing age and comorbidity. Furthermore, these patients often receive no treatment at all, resulting in local and/or systemic disease progression with associated symptoms and impaired quality of life (QoL). Recent data from randomized trials in young fit patients with early stage rectal cancer indicate that RT dose escalation can be safely delivered using external beam (chemo)radiotherapy (EBRT) followed by endoluminal radiotherapeutic modalities, such as contact X-ray brachytherapy (CXB) or high-dose rate endorectal brachytherapy (HDR-BT). However, prospective studies testing this therapeutic concept in elderly and frail patients remain limited. Here, we review the current evidence in the epidemiology and the management of elderly and frail patients with rectal cancer. We summarize the potential of RT dose escalation to achieve long-term local control of the primary tumour, prevent disease-related morbidity, improve QoL and even organ preservation. Future perspectives and open questions will be discussed as well.Copyright © 2022 Elsevier Ltd. All rights reserved.