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(P104) Trends in the Use of Neoadjuvant Radiotherapy for Rectal Cancer in the Academic Versus Community Setting

April 15, 2014
Publication
Article
OncologyOncology Vol 28 No 1S
Volume 28
Issue 1S
Conference|Annual Meeting of the American Radium Society (ARS)

The use of neoadjuvant radiotherapy is the standard of care in the treatment of locally advanced rectal cancer. The aim of our study was to identify if patients underwent radiation first vs surgery and if the treatment patterns changed with time.

Sanjay S. Reddy, MD, Elizabeth Handorf, PhD, Jeffrey M. Farma, MD, Elin R. Sigurdson, MD, PhD; Fox Chase Cancer Center

Introduction: The use of neoadjuvant radiotherapy is the standard of care in the treatment of locally advanced rectal cancer. The aim of our study was to identify if patients underwent radiation first vs surgery and if the treatment patterns changed with time. We examined differences between academic and community institutions and if concordance existed between clinical and pathological stage.

Methods: A retrospective analysis was performed using the National Cancer Database (NCDB), looking at all patients who were diagnosed with rectal cancer from 1998 to 2011. We tested differences in rates of treatment and stage migration using chi-square tests and logistic regression models.

Results: A total of 90,594 patients were identified having undergone both surgery and radiation for rectal cancer. In 1998, 42% of patients received radiation therapy (RT) prior to undergoing surgical resection. In 2000, 53% of patients were treated with neoadjuvant radiation. A steady increase in the use of induction radiation was observed during the study period, with 86% of patients treated with radiation prior to surgery in 2011, correlating with a 33% increase (P ≤ .001). When comparing the type of institution, academic vs community, in 1998, 51% of patients seen in an academic institution received radiation prior to surgical resection, vs 39% in a community facility (P ≤ .001). Although rates were consistently higher in academic institutions, both types demonstrated a consistent increase over the study period. In 2011, radiation was given first in 91% and 84% of patients in academic and community institutions, respectively (P ≤ .001). In patients receiving radiation first, 27% did not have clinical staging available. Overall, 17% of patients were successfully downstaged, 8% was upstaged, and 24% had no changes in stage. An additional 25% had no recorded pathological stage, 21% had unknown clinical stage, and 5% had no clinical or pathological staging available. When comparing academic vs community centers, 20% was downstaged, 8% was upstaged, and 26% had no changes in the academic centers, vs 15%, 8%, and 23% in the community, respectively (P ≤ .001). Staging was unknown in 46% in the academic institution and 54% of patients in the community (P ≤ .001).

Conclusion: The use of neoadjuvant radiation for the treatment of rectal cancers has seen a steady increase from 1998 to 2011. Although academic centers seem to have higher rates of adoption, the overwhelming majority of centers in the United States now follow a radiation-first strategy in the treatment of rectal cancer.

Articles in this issue

(P113) Age and Marital Status Are Associated With Choice of Mastectomy in Patients Eligible for Breast Conservation Therapy
(P112) Single-Institution Experience With Intrabeam IORT for Treatment of Early-Stage Breast Cancer
(P110) Breast Cancer Before Age 40: Current Patterns in Clinical Presentation and Local Management
(P111) Accelerated Partial-Breast Irradiation With Multicatheter High-Dose-Rate Brachytherapy: Feasibility and Results in a Private Practice Cohort
(P115) Breast Cancer Laterality Does Not Influence Overall Survival in a Large Modern Cohort: Implications for Radiation-Related Cardiac Mortality
(P117) Anatomical Variations and Radiation Technique for Breast Cancer
(P116) Bilateral Immediate DIEP Reconstruction and Postmastectomy Radiotherapy: Experience at a Tertiary Care Institution
(P118) Metadherin Overexpression Is Associated With Improved Locoregional Control After Mastectomy
(P119) Effect of Economic Environment on Use of Postlumpectomy Radiation Therapy for Stage I Breast Cancer
(P120) Immediate Versus Delayed Reconstruction After Mastectomy in the United States Medicare Breast Cancer Patient
(P121) Trend in Age and Racial Disparities in the Receipt of Postlumpectomy Radiation Therapy for Stage I Breast Cancer: 2004–2009
(P122) Streamlining Referring Physicians Orders With ‘Reflex Testing’ Significantly Decreases Time to Resolution for Abnormal Screening Mammograms
(P123) National Trends in the Local Management of Early-Stage Paget Disease of the Breast
(P124) Effect of Inhomogeneity on Cardiac and Lung Dose in Partial-Breast Irradiation Using HDR Brachytherapy
(P125) Breast Cancer Outcomes With Anthracycline-Based Chemotherapy for Residual Disease Burden After Full-Dose Neoadjuvant Chemotherapy and Surgery Followed by Radiation Treatment

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