The use of neoadjuvant chemoradiation for stage 2 and 3 rectal cancer is on the rise, but researchers are unsure whether this represents treatment innovation or greater disparity in cancer care.
Currently, the treatment of rectal cancer often includes the use of preoperative neoadjuvant chemoradiation, which has been shown to improve outcomes for patients with the disease. However, some studies have also found that non-operative management (NOM) for patients with stage 2 and 3 rectal cancer can result in a clinical complete response of up to 49%, raising questions about whether surgery can be omitted for these patients. Although most agree there is not yet enough evidence to support excluding surgery for the use of NOM exclusively, use of this treatment strategy may be increasing.
To confirm the presence of such a trend, Clayton Tyler Ellis, MD, University of North Carolina (Chapel Hill), and colleagues examined the use of NOM for rectal cancer, as well as patient- and facility-level factors associated with its use, over a 12-year period. Their findings were published in the Journal of Clinical Oncology.
Researchers looked at 146,135 patients with rectal cancer, 5741 of whom were treated with NOM and 140,394 of whom received surgery with or without additional therapy. All patients were treated between 1998 and 2010, and their data was obtained from the National Cancer Database.
Using univariate and multivariate analyses, researchers found that the use of NOM doubled from 1998 to 2010 (2.4% vs 5%). Patients who were black, uninsured, enrolled in Medicare, or treated at low-volume facilities were also found to be more likely to receive NOM than patients who were white, privately insured, and treated at a high-volume facility.
The authors concluded that, although NOM among patients with rectal cancer is rising, it might not be sign of better or more innovative care. They noted that more research will be needed to assess how survival can be effected by each strategy, and, in the meantime, NOM should only be pursued with well-informed patients in the context of a clinical trial.
