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Factors Associated With Receipt of Adjuvant Radiation in Locally Advanced Rectal Cancer
Maryam Sherwani1, Danish Ali2, Hanjoo Lee3
1Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Background:
Neoadjuvant radiotherapy (RT) has been the standard of care for locally advanced rectal cancer (LARC) for over two decades. Adjuvant RT use in LARC represents a deviation from standard care and warrants further investigation.
Objectives:
To identify factors associated with adjuvant RT utilization. We hypothesized that sociodemographic determinants contribute to differences in the sequence of radiation treatment among patients with rectal cancer.
Methods:
This retrospective cohort study utilized the National Cancer Database (2015-2022) to identify adults with clinical stage II-III rectal adenocarcinoma undergoing surgery and RT. Patients were categorized by RT sequence (neoadjuvant vs. adjuvant). Multivariable logistic regression identified factors associated with use of adjuvant RT.
Results:
Of the included 48 452 patients, 6.9% received adjuvant RT. Compared with the neoadjuvant group, adjuvant RT recipients exhibited higher rates of pathologic upstaging (20.5% vs. 10.3%), positive margins (14.7% vs. 6.3%), and lymphovascular invasion (17.4% vs. 11.3%; all p < 0.001). On multivariable analysis, positive margins (aOR 1.78, 95% CI 1.43-2.22), lymphovascular invasion (aOR 1.96, 95% CI 1.66-2.31), upstaging (aOR 1.63, 1.31-2.02) were independently associated with adjuvant RT.
Conclusions:
Adjuvant RT appeared to be used in patients who were found to have high-risk tumor pathology postoperatively.
