PURPOSE
In the United States, adjuvant radiation therapy is currently recommended for most patients with rectal cancer. We conducted this population-based study to evaluate the rate of radiation therapy and the factors affecting its delivery.
METHODS
We used the Surveillance Epidemiology and End Results database to assess treatment of patients with nonmetastatic rectal cancer diagnosed over a 25-year period (1976 through 2000). We evaluated the rate of radiation therapy use and its timing (preoperative vs. postoperative) and the influence of factors such as tumor stage and grade; patient gender and race; and geographic location.
RESULTS
In this 25-year period, 45,627 patients met our selection criteria. The rate of radiation therapy use increased dramatically over time: from 17 percent of advanced-stage patients in 1976 to 65 percent in 2000 (P < 0.0001). Until 1996, the increase was due almost entirely to postoperative radiation therapy. Since 1996, the rate of preoperative radiation therapy use has increased (P < 0.0001) and the rate of postoperative radiation therapy use has begun to decline. We found, after controlling for the year of diagnosis, that female patients, African Americans, older patients, and patients with low-grade lesions were less likely to undergo radiation therapy (P < 0.0001). Geographic location was also an important predictor of radiation therapy use.
CONCLUSIONS
The use of radiation therapy for patients with rectal cancer has dramatically increased over the 25-year period studied, with a recent shift to the use of preoperative radiation therapy; however, in 2000, over 30 percent of patients with advanced-stage nonmetastatic rectal cancer did not undergo radiation therapy. Given the variation in radiation therapy use that we found to be due to demographic factors, access to adjuvant radiation therapy can be improved.
Similar content being viewed by others
REFERENCES
American Cancer Society. Cancer facts and figures, 2004 http://www.cancer.org/downloads/STT/CAFF_finalPWSecured.pdf Accessed March 25, 2004.
JN Wiig E Carlsen O Soreide (1998) ArticleTitleMesorectal excision for rectal cancer: a view from Europe Semin Surg Oncol 15 78–86 Occurrence Handle1:STN:280:DyaK1czpvVWrsw%3D%3D Occurrence Handle9730413
JL McCall MR Cox DA Wattchow (1995) ArticleTitleAnalysis of local recurrence rates after surgery alone for rectal cancer Int J Colorectal Dis 10 126–32 Occurrence Handle1:STN:280:BymD2MfgvFI%3D Occurrence Handle7561427
F Kockerling MA Reymond A Altendorf-Hofmann O Dworak W Hohenberger (1998) ArticleTitleInfluence of surgery on metachronous distant metastases and survival in rectal cancer J Clin Oncol 16 324–9 Occurrence Handle1:STN:280:DyaK1c7gtFOisg%3D%3D Occurrence Handle9440760
AL Martling T Holm LE Rutqvist BJ Moran RJ Heald B Cedemark (2000) ArticleTitleEffect of a surgical training programme on outcome of rectal cancer in the County of Stockholm. Stockholm Colorectal Cancer Study Group, Basingstoke Bowel Cancer Research Project Lancet 356 93–6 Occurrence Handle10.1016/S0140-6736(00)02469-7 Occurrence Handle1:STN:280:DC%2BD3cvjtVensQ%3D%3D Occurrence Handle10963244
NIH Consensus Conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 1990;264:1444–50.
InstitutionalAuthorNameAnonymous (1997) ArticleTitleImproved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial N Engl J Med 336 980–7
E Kapiteijn CA Marijnen ID Nagtegaal et al. (2001) ArticleTitleDutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–46 Occurrence Handle10.1056/NEJMoa010580 Occurrence Handle1:STN:280:DC%2BD3Mvps1ektw%3D%3D Occurrence Handle11547717
InstitutionalAuthorNameColorectal Cancer Collaborative Group (2001) ArticleTitleAdjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials Lancet 358 1291–304
N Wolmark HS Wieand DM Hyams et al. (2000) ArticleTitleRandomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02 J Natl Cancer Inst 92 388–96
D Schrag SE Gelfand PB Bach J Guillem BD Minsky CB Begg (2001) ArticleTitleWho gets adjuvant treatment for stage II and III rectal cancer? Insight from surveillance, epidemiology, and end results--Medicare J Clin Oncol 19 3712–8
AI Neugut AT Fleischauer V Sundararajan et al. (2002) ArticleTitleUse of adjuvant chemotherapy and radiation therapy for rectal cancer among the elderly: a population-based study J Clin Oncol 20 2643–50
JZ Ayanian AM Zaslavsky CS Fuchs et al. (2003) ArticleTitleUse of adjuvant chemotherapy and radiation therapy for colorectal cancer in a population-based cohort J Clin Oncol 21 1293–300
JM Jessup AK Stewart HR Menck (1998) ArticleTitleThe National Cancer Data Base report on patterns of care for adenocarcinoma of the rectum, 1985-95 Cancer 83 2408–18 Occurrence Handle1:STN:280:DyaK1M%2FlsVaktQ%3D%3D Occurrence Handle9840542
C Camma M Giunta F Fiorica L Pagliaro A Craxi M Cottone (2000) ArticleTitlePreoperative radiotherapy for resectable rectal cancer: a meta-analysis JAMA 284 1008–15 Occurrence Handle10.1001/jama.284.8.1008 Occurrence Handle1:STN:280:DC%2BD3cvitFKjtQ%3D%3D Occurrence Handle10944647
R Sauer (2003) ArticleTitleAdjuvant versus neoadjuvant combined modality treatment for locally advanced rectal cancer: first results of the German rectal cancer study (CAO/ARO/AIO-94) Int J Radiat Oncol Biol Phys 57 S124–5 Occurrence Handle10.1016/S0360-3016(03)00824-1 Occurrence Handle1:STN:280:DC%2BD3svisFSgtQ%3D%3D
O Reerink RC Verschueren BG Szabo GA Hospers NH Mulder (2003) ArticleTitleA favourable pathological stage after neoadjuvant radiochemotherapy in patients with initially irresectable rectal cancer correlates with a favourable prognosis Eur J Cancer 39 192–5 Occurrence Handle1:STN:280:DC%2BD3s%2Fgtl2nsg%3D%3D Occurrence Handle12509951
AE Uzcudun JF Batlle JC Velasco et al. (2002) ArticleTitleEfficacy of preoperative radiation therapy for resectable rectal adenocarcinoma when combined with oral tegafur-uracil modulated with leucovorin: results from a phase II study Dis Colon Rectum 45 1349–58 Occurrence Handle12394434
J Garcia-Aguilar E Hernandez de Anda P Sirivongs SH Lee RD Madoff DA Rothenberger (2003) ArticleTitleA pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision Dis Colon Rectum 46 298–304 Occurrence Handle10.1007/s10350-004-6545-x Occurrence Handle12626903
G Luppi M Santantonio F Bertolini et al. (2003) ArticleTitlePreoperative concomitant radiotherapy and chemotherapy in ultrasound-staged T3 and T4 rectal cancer Tumori 89 152–6
AM Morris KG Billingsley NN Baxter LM Baldwin (2004) ArticleTitleRacial disparities in rectal cancer treatment: a population-based analysis Arch Surg 139 151–5 Occurrence Handle14769572
ACKNOWLEDGMENT
The authors thank Dr. Mary Knatterud for her helpful editorial comments.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported in part by the University of Minnesota Cancer Center.
Reprints are not available.
About this article
Cite this article
Baxter, N., Rothenberger, D., Morris, A. et al. Adjuvant Radiation for Rectal Cancer: Do We Measure Up to the Standard of Care? An Epidemiologic Analysis of Trends Over 25 Years in the United States. Dis Colon Rectum 48, 9–15 (2005). https://doi.org/10.1007/s10350-004-0792-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0792-8