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Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer.

Publication ,  Conference
Sun, Z; Adam, MA; Kim, J; Hsu, S-WD; Palta, M; Czito, BG; Migaly, J; Mantyh, C
Published in: Journal of Clinical Oncology
February 1, 2016

657 Background: Prospective randomized trials have demonstrated that neoadjuvant chemoradiation improves local control and results in a higher rate of sphincter-sparing surgery for patients with locally advanced rectal cancer. However, neoadjuvant therapy utilization and population-based outcomes are not well defined. Methods: Adults with stage II/III rectal adenocarcinoma within the National Cancer Data Base undergoing surgery between 2006-2012 were analyzed. Patients were grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only, or concomitant chemoradiation. Multivariable modeling was used to compare perioperative outcomes and overall survival between groups. Results: Among 32,978 patients included, 9,714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1,170 (3.5%) radiotherapy only, and 21,204 (64.3%) concomitant chemoradiation. 5-year overall survival among groups was 62%, 69%, 71%, and 74%, respectively. Compared to no therapy, chemotherapy or radiotherapy alone was not associated with any differences in perioperative or oncologic outcomes (all p > 0.05). With adjustment for patient and disease characteristics, neoadjuvant chemoradiation was associated with a lower likelihood of margin positivity (OR 0.74, p < 0.001), need for permanent colostomy (OR 0.77, 95% CI 0.70-0.85, p < 0.001), 30-day mortality (OR 0.67, p = 0.003), and overall survival (HR 0.69, p < 0.001). When compared to chemotherapy or radiotherapy alone, neoadjuvant chemoradiation was still associated with improved overall survival (vs. chemotherapy: HR 0.83, p = 0.04; vs. radiotherapy: HR 0.75, p < 0.001). Conclusions: Neoadjuvant chemoradiation, not chemotherapy or radiotherapy alone, is important for sphincter-preservation and survival for patients with locally advanced rectal cancer. Despite this finding, one third of patients with locally advanced rectal cancer are failing to receive this therapy in the United States.

Duke Scholars

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

February 1, 2016

Volume

34

Issue

4_suppl

Start / End Page

657 / 657

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sun, Z., Adam, M. A., Kim, J., Hsu, S.-W., Palta, M., Czito, B. G., … Mantyh, C. (2016). Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer. In Journal of Clinical Oncology (Vol. 34, pp. 657–657). American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.2016.34.4_suppl.657
Sun, Zhifei, Mohamed A. Adam, Jina Kim, Shiao-Wen D. Hsu, Manisha Palta, Brian G. Czito, John Migaly, and Christopher Mantyh. “Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer.” In Journal of Clinical Oncology, 34:657–657. American Society of Clinical Oncology (ASCO), 2016. https://doi.org/10.1200/jco.2016.34.4_suppl.657.
Sun Z, Adam MA, Kim J, Hsu S-WD, Palta M, Czito BG, et al. Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer. In: Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2016. p. 657–657.
Sun, Zhifei, et al. “Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer.Journal of Clinical Oncology, vol. 34, no. 4_suppl, American Society of Clinical Oncology (ASCO), 2016, pp. 657–657. Crossref, doi:10.1200/jco.2016.34.4_suppl.657.
Sun Z, Adam MA, Kim J, Hsu S-WD, Palta M, Czito BG, Migaly J, Mantyh C. Effect of combined neoadjuvant chemoradiation on overall survival for patients with locally advanced rectal cancer. Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2016. p. 657–657.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

February 1, 2016

Volume

34

Issue

4_suppl

Start / End Page

657 / 657

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences