Poor compliance to National Comprehensive Cancer Network (NCCN) guidelines for adjuvant chemotherapy appears to be associated with poorer overall survival in patients with locally advanced rectal cancer who received neoadjuvant chemoradiotherapy, a study published in the journal Cancer has shown.1

NCCN treatment guidelines for patients with locally advanced rectal cancer recommend neoadjuvant chemoradiation followed by total mesorectal excision and adjuvant chemotherapy. Researchers sought to assess compliance to these guidelines and the relationship between the rate of adjuvant chemotherapy and survival.

For the study, investigators analyzed data from 14,742 patients with stage II or III rectal cancer who underwent neoadjuvant chemoradiotherapy and surgical resection and were included in the National Cancer Data Base. Of those, 68% did not receive adjuvant chemotherapy.

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Results showed that patients older than 70 years, those who had a higher comorbidity score, and those who achieved a pathologic complete response were less likely to receive adjuvant chemotherapy.

The rate of the use of adjuvant therapy was 22-fold lower among hospitals.

After controlling for patient factors, stage of disease, and pathologic response, researchers found that adjuvant therapy was associated with an improvement in 5-year overall survival (hazard ratio [HR], 0.65; 95% CI, 0.59-0.71), with greatest survival benefit observed among those who achieved a pathologic complete response (HR, 0.40; 95% CI, 0.23-0.67).

The authors propose improved rehabilitation and physical conditioning as strategies that may improve the odds of patients receiving adjuvant therapy.


1. Xu Z, Mohile SG, Tejani MA, et al. Poor compliance with adjuvant chemotherapy use associated with poorer survival in patients with rectal cancer: an NCDB analysis. Cancer. 2016 Aug 25. doi: 10.1002/cncr.30261. [Epub ahead of print]