The Evolving Role of Hypofractionated Radiotherapy in Older Adults with Gastrointestinal Cancers

While radiotherapy treatment of gastrointestinal (GI) malignancies has historically involved 5–6 weeks of low dose fractions of radiation, hypofractionated radiation over 1–4 weeks has emerged as an efficacious alternative in treatment of many cancer types, including GI cancers. Hypofractionation is of particular relevance in the treatment of older adult patients, wherein the balance between cancer cure, toxicity, goals of care and convenience must be carefully weighed. The role of hypofractionated radiation in the definitive treatment of GI malignancies remains an active area of investigation in sites such as the esophagus, anus, and pancreas, an efficacious alternative for unresectable cases hepatocellular carcinoma and cholangiocarcinoma and standard of care for locally advanced rectal cancer. Meanwhile, hypofractionated radiation therapy represents an efficacious method of palliation for all GI cancers. In this review, we will discuss the application of hypofractionation in gastrointestinal malignancies by disease subsite, with a focus on caring for older adults.