Background: The incidence of CRC increases with age. Future numbers are projected to rise due to an ageing population. Little data exists on chemotherapy in those ≥80 years (yrs) with CRC, a subgroup rarely included in clinical trials. The purpose of this study was to evaluate chemotherapy use, feasibility and tolerability in patients ≥80 yrs with CRC in a single institution. Methods: CRC diagnosed in those ≥80 yrs in a single institution in Ireland , from 2004 -2009, was determined. Clinicopathological data collected included age, gender, morphology, stage, and treatment including surgery, radiation or chemotherapy. In those receiving chemotherapy tolerance was determined by dose delays, reductions and number of completed cycles. Results: 83 cases of CRC were identified; 80-89 yrs (n=78), 90-100 yrs (n=5). Median age was 84 yrs (range 80-102), 38/83 (45.8%) were female. 59 cases of colon and 24 cases of rectal cancer were seen. Stage at diagnosis included IV (n=18), III (n=21), II (n=38) and I (n=6). For stage IV disease 4/18 (22%) received chemotherapy. Median overall survival for those with stage IV disease who received chemotherapy was 317 days (range 64-487) versus 169 days (range 30-473) for supportive care. 3/21(14%) stage III patients received chemotherapy. Median survival for stage III disease who received chemotherapy was 1193 days (range 432-1640) compared to 641 days who did not (range 0-1640). All patients with stage IV disease received single agent (SA) treatment (capecitabine n=3, cetuximab n=1). Treatment of stage III disease included: XELOX n=1, 5Fluorouracil/Leucovorin n=1, capecitabine n=1). 3/6 (50%) had dose reductions (n=4) and delays (n=7) in treatment. 1 patient completed scheduled adjuvant treatment. 1 patient with metastatic disease received second and third line treatment (SA irinotecan, cetuximab). Data including performance status, co morbidity will be presented. Conclusions: The uptake of chemotherapy in this cohort is low. Although the rates of treatment modifications are high, those treated appear to benefit. Better clinical tools are needed to differentiate those older patients likely to benefit from systemic therapy and those better served by supportive measures alone.