Standard treatment of patients with stage II and III rectal cancer consists of a multimodality approach, including the use of chemotherapy, radiation, and surgery.
Christina J. Wai, MD, Jeffrey M. Farma, MD, Margaret O’Grady, RN, MSN, Kelly Filchner, RN, MSN, Elaine Sein, RN, MSN, Elizabeth Handorf, PhD, Steven Cohen, MD, Melanie Pirollo, MS, RN, AOCN, Ashok Bapat, MD, Rachelle Lanciano, MD, Sonyo Shin, MD, Wei Song, MD, PhD, Elin R. Sigurdson, MD, PhD; Fox Chase Cancer Center; Hartford Hospital; Inspira Health Network; Virtua, Crozer Keystone Health System; Easton Hospital; Pottstown Memorial Medical Center
Introduction: Standard treatment of patients with stage II and III rectal cancer consists of a multimodality approach, including the use of chemotherapy, radiation, and surgery. Current National Comprehensive Care Network (NCCN) guidelines recommend that patients with stage II and III rectal cancer receive neoadjuvant chemoradiotherapy to decrease local recurrence rates.
Methods: We performed a retrospective chart review of patients treated for stage II and III rectal cancer at a tertiary referral cancer center and six of its community partner institutions from 2000–2011. We sought to evaluate the use of neoadjuvant and adjuvant chemotherapy and radiotherapy in these patients.
Results: There were 769 stage II and III rectal cancer patients treated at the seven institutions. Of them, 513 were clinical stage II and III patients, with 253 being stage II and 260 being stage III. Among the 513 patients, 316 (61.6%) were male, while 197 (38.4%) were female, and the median age at diagnosis of rectal cancer was 64 years. There were 449 patients out of the 513 (87.5%) who received neoadjuvant therapy. For stage II patients, there were 215 out of 253 (85%) who received neoadjuvant therapy. There were 234 out of 260 (90%) stage III patients who received neoadjuvant therapy. Most patients, 438 out of 449 (97.6%), received both neoadjuvant chemotherapy and radiotherapy. Four patients (0.9%) received only neoadjuvant chemotherapy, and seven (1.6%) received only neoadjuvant radiotherapy. Of the 64 patients who did not receive neoadjuvant therapy, 38 (59.4%) received adjuvant therapy and 26 (40.6%) did not receive any other therapy. When comparing the tertiary cancer center to the community partnering institutions, 191 out of 205 (93.2%) of the stage II and III patients received neoadjuvant therapy at the tertiary center, while 258 out of 308 (83.8%) received neoadjuvant treatment at the partnering institutions. The difference was statistically significant (P = .002).
Discussion: Rectal cancer care across the US is provided at both community and academic centers. In general, academic centers tend to adopt practice changes sooner than community hospitals. At both our institution and partnering hospitals, there was a high rate of neoadjuvant therapy use in accordance with NCCN guidelines. However, patients at the tertiary center were more likely to receive neoadjuvant therapy, which may likely be due to the center being a part of early protocols that helped to establish the guidelines of neoadjuvant therapy use in rectal cancer. With the partnering relationship of community hospitals with tertiary centers like ours, which has an educational platform via tumor boards and regional symposiums, this can provide an opportunity for increased standardization of care across all hospitals so that rectal cancer patients are treated in accordance with current guidelines.