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

Abstract

BACKGROUND In the United States, neoadjuvant chemoradiotherapy (NACRT) is widely accepted as the standard of care in the treatment of patients with locally advanced rectal cancer. In the current study, the authors attempted to examine patterns of treatment in the United States over the past decade. METHODS Using the National Cancer Data Base, a total of 66,197 patients who were diagnosed with American Joint Committee on Cancer stage II to III rectal adenocarcinoma and treated between 2004 and 2012 were identified. The authors described trends in the receipt of treatment for 3 time periods (2004‐2006, 2007‐2009, and 2010‐2012) and analyzed 5‐year overall survival probabilities for 28,550 patients treated between 2004 and 2007. RESULTS Receipt of NACRT increased significantly from 42.9% between 2004 and 2006 to 50.0% between 2007 and 2009, and to 55.0% between 2010 and 2012 (P < .0001). In contrast, the use of adjuvant chemoradiotherapy (CRT) decreased from 16.7% between 2004 and 2006 to 10.5% between 2007 and 2009, and to 6.7% between 2010 and 2012 (P < .0001). Similarly, the use of surgery alone decreased from 13.1% between 2004 and 2006 to 8.7% between 2010 and 2012 (P < .0001). Older age, the 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 were associated with a significantly lower possibility of receiving NACRT. The 5‐year overall survival rates for patients treated with NACRT, surgery and adjuvant CRT, surgery alone, and definitive CRT were 72.4%, 70.9%, 44.9%, and 48.8%, respectively. CONCLUSIONS The use of NACRT before surgery in US patients with rectal cancer has substantially increased over the past decade. However, only approximately one‐half of patients currently receive this standard therapy, which could be explained in part by socioeconomic factors. Trimodality therapy is associated with the best outcomes for these patients. Cancer 2016;122:1996–2003. © 2016 American Cancer Society.

Neoadjuvant long‐course chemoradiation remains strongly favored over short‐course radiotherapy by radiation oncologists in the United States

“…9 Concerns regarding limited clinical trial follow-up, late toxicity, and insufficient downstaging with SC-RT were the primary factors causing respondents in the current study to favor LC-CRT over SC-RT. To our knowledge, no other surveys to date have addressed the attitudes of radiation oncologists toward SC-RT for patients with rectal cancer.…”

“…This may reflect differences in familiarity with the relevant literature and/or incentivization systems among academic versus nonacademic practices. 9 The results of this survey indicate that LC-CRT remains the favored neoadjuvant radiation regimen for patients with rectal cancer in the United States, despite widespread awareness of randomized data supporting the use of SC-RT. 38 Although LC-CRT was the favored regimen for the majority of survey respondents, the results of the current study indicate a willingness to use SC-RT in certain circumstances, such as patients who are declining or unable to receive chemotherapy or with a geographic barrier to receiving LC-CRT.…”

“…Potential benefits for the short-course regimen include lower cost, improved patient convenience, and lower rates of acute toxicity. 9 Different practice patterns are reflected in consensus guidelines. 6,7 Because both SC-RT and LC-CRT are effective, the optimal approach is a matter of significant debate.…”

Why is neoadjuvant chemoradiation therapy underused for locally advanced rectal cancer?

“…A report from the NCDB on treatment strategies used in LARC highlighted an increase in multimodal treatment (both NCRT and adjuvant CRT) from 1985 to 1986, 1989 to 1990 and 1994 to 1995. An update on NCDB data of almost 60,000 patients aged >18 years with a diagnosis of stage II or III rectal cancer treated between 2004 and 2012 was recently published by Sineshaw et al [4]. Overall, data were consistent with the increased use of the trimodality treatment, administered in about 60% of cases and associated with the best 5-year overall survival rate of >70%.…”

Árangur brottnáms á endaþarmi vegna krabbameins eða forstiga þess á Landspítala 2008-2012

“…19 Þá sýnir stór bandarísk samantekt frá 2016 72% 5 ára lifun hjá sjúklingum með endaþarmskrabbamein á stigi 2-3 sem fengu geisla-og lyfjameðferð fyrir aðgerð. 20 Þýsk rannsókn frá 2012 er tók fyrir sama sjúklingahóp sýndi fram á 75% 5 ára lifun og 5% staðbundna endurkomutíðni. 21 Nýlegri rannsókn sýndi fram á 81,5% sjúkdómsfría 5 ára lifun með 3,6% endurkomutíðni en þar var meðaltími eftirfylgdar þrjú ár.…”