title: Neoadjuvant radiotherapy use in locally advanced rectal cancer at NCCN member institutions.
abstract: Based on randomized data, neoadjuvant chemoradiotherapy has been incorporated into the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for stage II-III rectal cancer. Factors associated with nonadherence to evidence-based guidelines for neoadjuvant radiotherapy (RT) were examined at dedicated cancer centers. The prospective NCCN Oncology Outcomes Database for Colorectal Cancers was queried for patients with stage II-III rectal cancer who underwent a transabdominal surgical resection between September 2005 and June 2012. Multivariable logistic regression was used to identify factors associated with omission of RT. Among 1199 identified patients, 1119 (93%) received neoadjuvant RT, 51 (4%) did not receive RT, and 29 (2%) received adjuvant RT. Among 51 patients not receiving RT, only 19 (37%) were referred and evaluated by a radiation oncologist. On multivariable analysis, clinical factors associated with not receiving RT included a history of prior pelvic RT (adjusted odds ratio [aOR], 23.9; P=.0003), ECOG performance status of 2 or greater (aOR, 11.1; P=.01), tumor distance from the anal verge greater than 10 cm (aOR, 5.4; P=.009), age at diagnosis of 75 years or older (aOR, 4.43; P=.002), body mass index of 25 to 30 kg/m(2) and less than 25 kg/m(2) (aOR, 5.22 and 4.23, respectively; P=.03), and clinical stage II (aOR, 2.27; P=.02). No significant change was seen in RT use according to diagnosis year, nor was any correlation seen with distance to the nearest RT facility. Concordance with NCCN Guidelines for neoadjuvant RT is high among NCCN Member Institutions. After adjusting for clinical characteristics that increase the risk for RT toxicity, including history of pelvic RT and high comorbidity burden/low functional status, the authors found that non-obese patients of advanced age or those with more favorable clinical features were more likely to not receive RT.
authors.affiliation: From aDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York; bDepartments of Information Sciences and cBiostatistics, City of Hope Comprehensive Cancer Center, Duarte, California; dDepartment of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; eDivision of Medical Oncology, Department of Medicine, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio; fDepartment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania; gDepartment of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California; hDepartment of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; iDepartment of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois; jDepartment of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and kDepartment of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Marsha
authors.initials: M
authors.lastname: Reyngold
authors.forename: Joyce
authors.initials: J
authors.lastname: Niland
authors.forename: Anna
authors.initials: A
authors.lastname: ter Veer
authors.forename: Dana
authors.initials: D
authors.lastname: Milne
authors.forename: Tanios
authors.initials: T
authors.lastname: Bekaii-Saab
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Cohen
authors.forename: Lily
authors.initials: L
authors.lastname: Lai
authors.forename: Deborah
authors.initials: D
authors.lastname: Schrag
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.forename: Martin
authors.initials: M
authors.lastname: Weiser
authors.forename: Neal
authors.initials: N
authors.lastname: Wilkinson
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult