Inferior Rectal Cancer OS With Chemoradiotherapy Alone

Real-world data suggest that foregoing surgery after chemoradiotherapy may not be the best option for patients with stage II or III rectal adenocarcinoma

medwireNews: Treatment with chemoradiotherapy alone results in significantly reduced overall survival (OS) compared with when it is followed by surgery in patients with rectal adenocarcinoma, according to a research letter published in JAMA Oncology.

Using the National Cancer Database, the researchers identified 1655 patients who received chemoradiotherapy alone for stage II or III rectal cancer, while their 14,207 counterparts underwent “conventional treatment” comprising chemoradiotherapy and proctectomy.

OS was shorter for patients in the chemoradiotherapy alone group than for those who also received surgery, with 3- and 5-year survival rates of 71.34% versus 88.29% and 58.21% versus 77.12%, respectively. This equated to a significant 1.90-fold increased risk of death for patients given chemoradiotherapy alone.

The elevated risk with chemoradiotherapy alone persisted after adjustment for confounding factors, such as race, insurance status, comorbidity score and tumour grade, with an adjusted hazard ratio of 1.69, reports the team from the University of North Carolina at Chapel Hill in the USA.

Highlighting that their results are contrary to previous single-institution and clinical trial results, C Tyler Ellis and co-researchers say: “This finding is likely because chemoradiotherapy only can be viewed at once as both an innovative treatment paradigm in some settings and low-quality care in others.

“Although [nonoperative management] is an intentional approach for some patients, it is likely that many individuals forgoing surgery in the community are doing so as a result of systematic barriers. Our results point to disparities in the process of rectal cancer care where historically disadvantaged groups receive suboptimal care and experience worse outcomes.”

The authors point out that they could not determine whether patients responded completely to chemoradiotherapy or whether they failed to receive surgery for other reasons.

However, given that the use of chemoradiotherapy alone “has doubled among individuals with nonmetastatic rectal adenocarcinoma”, they find the results “concerning”.

The team concludes: “As [nonoperative management] becomes an increasingly accepted treatment approach, more comparative effectiveness studies evaluating outcomes in the real-world setting will be needed.”

Reference

Ellis CT, Dusetzina SB, Sanoff H, Stitzenberg KB. Long-term survival after chemoradiotherapy without surgery for rectal adenocarcinoma: a word of caution. JAMA Oncol; Advance online publication 20 October 2016. doi:10.1001/jamaoncol.2016.3424

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