title: Combined-modality therapy for rectal cancer: analysis of potential differences in disease presentation, treatment adherence, and treatment outcome according to race.
abstract: OBJECTIVE
  Population-based studies suggest African Americans (AAs) with rectal cancer have a worse overall outcome compared with non-AAs. This relationship was explored in a cohort of rectal cancer patients treated with preoperative chemoradiation therapy (CRT) and surgery at 2 academic cancer centers.
  
  
  METHODS
  A total of 146 patients (26 AA, 120 non-AA) underwent treatment with curative intent. The median age was 57 years. Median dose was 50.4 Gy, given with 5-fluorouracil-based concurrent chemotherapy. Differences in disease presentation, adherence to recommended therapy, and treatment outcome (freedom from failure) by race were analyzed. Median follow-up was 34 months from completion of CRT.
  
  
  RESULTS
  AAs had longer time from diagnosis to start of therapy (median, 45 vs. 35 d; P<0.01) and from CRT completion to surgery (median, 42 vs. 46 d; P=0.03). AA patients presented with more favorable disease (20% stage I, 33% stage III) compared with non-AA patients (0% stage I, 48% stage III, P<0.01). AA patients were less likely to receive adjuvant chemotherapy (58% vs. 89%, P=0.01). Log-rank analysis showed AAs were not more likely to recur after therapy (freedom from failure at 3 y, 100% for AA patients vs. 81% for non-AA patients, P=0.09). The difference in time from preoperative therapy to surgery and a lower rate of adjuvant therapy in AA patients did not seem to result in inferior disease outcome for this cohort.
  
  
  CONCLUSIONS
  Further study is necessary to explore the reasons underlying the delays in therapy and lower rates of adjuvant chemotherapy for AA patients.
authors.affiliation: Departments of *Radiation and Cellular Oncology ‡Medical Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL †Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Tonlaar
authors.forename: Suisui
authors.initials: S
authors.lastname: Song
authors.forename: Julian C
authors.initials: JC
authors.lastname: Hong
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Minsky
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
authors.forename: Blase N
authors.initials: BN
authors.lastname: Polite
authors.forename: Stanley L
authors.initials: SL
authors.lastname: Liauw
mesh_terms: D001741:Black or African American; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012004:Rectal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005472:Fluorouracil