Substantial Increase in Use of Neoadjuvant Chemoradiotherapy for Rectal Cancer

Use of neoadjuvant chemoradiotherapy before surgery among patients with rectal cancer has substantially increased over the past decade.
Use of neoadjuvant chemoradiotherapy before surgery among patients with rectal cancer has substantially increased over the past decade.

Use of neoadjuvant chemoradiotherapy (NACRT) before surgery among patients in the United States with rectal cancer has substantially increased over the past decade, according to a study published in Cancer.1

However, only approximately one-half of patients receive NACRT as standard therapy, possibly due to socioeconomic factors.

Researchers led by Helmneh Sineshaw, MD, MPH, of the American Cancer Society in Atlanta, Georgia, looked at 66 197 patients with American Joint Committee on Cancer stage II to III rectal adenocarcinoma through the National Cancer Data Base who were treated between 2004 and 2012.

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They examined trends in receipt of treatment over 3 time periods (2004 to 2006, 2007 to 2009, and 2010 to 2012), and also analyzed 5-year overall survival probabilities for 28 550 patients who were treated between 2004 to 2007.

The study found that receipt of NACRT increased from 42.9% between 2004 and 2006 to 50% between 2007 to 2009, and to 55% between 2010 and 2012.

Meanwhile, use of adjuvant chemoradiotherapy was found to have decreased from 16.7% between 2004 and 2006 to 10.5% between 2007 and 2009, and to 6.7% between 2010 and 2012. Use of surgery also decreased from 13.1% between 2004 and 2006 to 8.7% between 2010 and 2012.

Factors that were associated with a significantly lower possibility of receiving NACRT were older age, presence of comorbidities, larger primary tumor size, lymph node involvement, not being of non-Hispanic white race/ethnicity, lack of private insurance, and treatment at a facility that did not have a high case volume.

Five-year overall survival rates were 72.4% for NACRT, 70.9% for surgery and adjuvant CRT, 44.9% for surgery alone, and 48.8% for definitive CRT.

REFERENCE

1. Sineshaw HM, Jemal A, Thomas Jr CR, et al. Changes in treatment patterns for patients with locally advanced rectal cancer in the United States over the past decade: an analysis from the National Cancer Data Base [published online ahead of print April 13, 2016]. Cancer. doi:10.1002/cncr.29993.

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