Nearly 50% of patients with stage II/III rectal cancer achieve a complete clinical response via neoadjuvant chemoradiation, but opinions in the medical community regarding the efficacy of nonoperative management is mixed. A team of researchers, based at the University of North Carolina, Chapel Hill, sought to review trends in nonoperative management for rectal adenocarcinoma.1
The research team revised the records of 146 135 patients; persons included in the study reported invasive, nonmetastatic rectal adenocarcinoma to the National Cancer Database and either received nonoperative management (5741 persons) or surgery with or without additional therapy (140 394 persons).
During the 1998 to 2010 period (during which all included patients reported), the use of nonoperative management doubled.
The researchers found a disproportionate use of nonoperative management among patients who were black, treated at low-volume treatment centers, and/or were uninsured; raising some concern that use of nonoperative management may represent a treatment disparity rather than an improved direction in rectal cancer care.
The investigators suggest continued exploration of nonoperative management in the clinical trial setting to help determine survival rates for chemoradiation-only care, or nonoperative management, vs other treatment.
1. Ellis C, Samuel C, Stitzenberg K. National trends in nonoperative management of rectal adenocarcinoma [published online ahead of print March 28, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.64.2066.