Not complying with recommendations found in National Comprehensive Cancer Network (NCCN) guidelines for locally advanced rectal cancer may led to worse overall survival, according to a study published in the journal Cancer.
Currently, NCCN guidelines for patients with locally advanced rectal cancer include neoadjuvant chemoradiation followed by total mesorectal excision and adjuvant chemotherapy. Researchers led by Zhaomin Xu, MD, University of Rochester Medical Center, NY, sought to assess compliance to these guidelines and how adjuvant chemotherapy use affected survival.
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For their study, researchers analyzed data from 14,742 patients in the National Cancer Data Base with stage II or III rectal cancer who underwent neoadjuvant chemoradiotherapy and surgical resection. A mixed effects multivariable logistic regression identified factors associated with the receipt of adjuvant chemotherapy and 5-year overall survival was the primary endpoint.
Overall, 68% of patients included in the study did not receive adjuvant chemotherapy. Patients who were older than 70 years, had a higher comorbidity score, and had a pathologic complete response were less likely to receive adjuvant therapy. The rate of adjuvant therapy use was 22-fold lower among hospitals.
Further, after controlling for patient factors, stage of disease, and pathologic response, researchers found that adjuvant therapy was associated with increased 5-year overall survival, with the greatest benefit observed in patients who achieved pathologic complete response.
From these results, researchers concluded that adjuvant therapy appears to be independently associated with improved overall survival, regardless of stage of disease, pathologic response, and patient factors. However, there is still poor compliance to NCCN guidelines for adjuvant chemotherapy in patients with locally advanced rectal cancer after neoadjuvant radiation and surgery. They propose that improved rehabilitation and physical conditioning could improve the odds of patients receiving adjuvant therapy.
