title: Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States.
abstract: Short-course radiotherapy (SC-RT) and long-course chemoradiotherapy (LC-CRT) are accepted neoadjuvant treatments of rectal cancer. In the current study, the authors surveyed US radiation oncologists to assess practice patterns and attitudes regarding SC-RT and LC-CRT for patients with rectal cancer.
  
  
  
  The authors distributed a survey to 1701 radiation oncologists regarding treatment of neoadjuvant rectal cancer. Respondents were asked questions regarding the number of patients with rectal cancer treated, preference for SC-RT versus LC-CRT, and factors influencing regimen choice.
  
  
  
  Of 1659 contactable physicians, 182 responses (11%) were received. Approximately 83% treated at least 5 patients with rectal cancer annually. The majority of responding radiation oncologists (96%) preferred neoadjuvant LC-CRT for the treatment of patients with locally advanced rectal cancer and 44% never used SC-RT. Among radiation oncologists using SC-RT, respondents indicated they would not recommend this regimen for patients with low (74%) or bulky tumors (70%) and/or concern for a positive circumferential surgical resection margin (69%). The most frequent reasons for not offering SC-RT were insufficient downstaging for sphincter preservation (53%) and a desire for longer follow-up (45%). Many radiation oncologists indicated they would prescribe SC-RT for patients not receiving chemotherapy (62%) or patients with a geographic barrier to receiving LC-CRT (82%). Patient comorbidities appeared to influence regimen preferences for 79% of respondents. Approximately 20% of respondents indicated that altered oncology care reimbursement using capitated payment by diagnosis would impact their consideration of SC-RT.
  
  
  
  US radiation oncologists rarely use neoadjuvant SC-RT despite 3 randomized controlled trials demonstrating no significant differences in outcome compared with LC-CRT. Further research is necessary to determine whether longer follow-up coupled with the benefits of lower cost, increased patient convenience, and lower acute toxicity will increase the adoption of SC-RT by radiation oncologists in the United States. Cancer 2017;123:1434-1441. © 2016 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Yvonne M
authors.identifier: 0000-0002-9839-2414
authors.initials: YM
authors.lastname: Mowery
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Salama
authors.affiliation: Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: S Yousuf
authors.identifier: 0000-0002-9039-5258
authors.initials: SY
authors.lastname: Zafar
authors.affiliation: Department of Surgery, Duke University, Durham, North Carolina.
authors.forename: Harvey G
authors.initials: HG
authors.lastname: Moore
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Christopher G
authors.identifier: 0000-0002-4573-4302
authors.initials: CG
authors.lastname: Willett
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Czito
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: M Benjamin
authors.initials: MB
authors.lastname: Hopkins
authors.affiliation: Department of Radiation Oncology, Duke University, Durham, North Carolina.
authors.forename: Manisha
authors.initials: M
authors.lastname: Palta
mesh_terms: D001290:Attitude; D059248:Chemoradiotherapy; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians'; D000072378:Radiation Oncologists; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D014481:United States / Q000453:epidemiology
keywords: health care policy; hypofractionation; long-course chemoradiotherapy; rectal cancer; short-course radiotherapy