Patients with stage II or stage III rectal cancer may have better outcomes when treated with surgery and chemoradiotherapy than those who receive chemoradiotherapy alone, according to an article published in JAMA Oncology.
Some small-scale studies from specialized centers have reported success with nonoperative management or the watch-and-wait approach after neoadjuvant chemoradiotherapy for rectal cancer; however, it is unknown whether these results could be duplicated in the broader population.
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C Tyler Ellis, MD, MSCR, University of North Carolina, Chapel Hill, and colleagues theorized that those treated without surgery would actually have worse overall survival than those who did.
Using The National Cancer Data Base, they identified patients treated for stage II or III rectal cancer between January 2004 and December 2008. These patients were divided into two cohorts, those who received chemoradiotherapy alone, and those who received chemoradiotherapy followed by proctectomy.
Compared with patients who only received chemoradiotherapy, those in the surgery group experienced a more favorable overall survival at 36 months (71.3% vs 88.2%) and 60 months (58.2% vs 77.1%) from diagnosis. These results persisted even after researchers adjusted for potential confounding factors, including race, insurance type or status, and treatment center volume.
“From these data, we cannot know whether patients were receiving nonoperative management and had a complete response to chemoradiotherapy or whether patients failed to receive surgery for other reasons,” Dr Ellis and colleagues concluded. “However, the results are concerning. As nonoperative management becomes an increasingly accepted treatment approach, more comparative effectiveness studies evaluating outcomes in the real-world setting will be needed.”
