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Radiation therapy plus surgery extended OS in metastatic rectal cancer
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Patients with primary rectal or rectosigmoid tumors treated with pelvic radiation therapy plus surgery demonstrated longer survival than those treated with surgery alone, according to study results.
The combination treatment was more common in patients with primary rectal tumors, whereas patients with rectosigmoid tumors more commonly underwent surgery alone.
Researchers used the SEER database to evaluate data from 6,873 patients with stage IV rectal cancer and 3,417 patients with rectosigmoid cancer.
Among patients with rectum primary tumor site, 20.5% underwent surgery alone and 38.7% underwent radiation therapy with or without surgery.
Among patients with rectosigmoid tumors, 51.4% underwent surgery alone and 15.1% underwent radiation therapy with or without surgery.
After stratifying for tumor stage, researchers found patients with in situ through T2 tumors were significantly more likely to receive radiation therapy than patients with T3 or T4 tumors (P˂.001).
Patients with lymph node-negative disease were more likely to receive radiation than those with lymph node-positive disease (P˂.001).
Researchers observed substantially improved OS rates at 2 years and 5 years among patients who underwent surgery and radiation.
Among patients with rectal primary tumors, 2-year OS was 28% among those who received radiation therapy alone and 45% among those who underwent surgery alone. Two-year survival rates ranged from 54% to 67% among patients who received some form of radiation plus surgery.
Five-year OS was 6% among those who underwent radiation alone and 13% among those who underwent surgery alone. Rates ranged from 24% to 28% among patients who underwent surgery plus some form of radiation.
Among patients with rectosigmoid primary tumors, 2-year OS was 20% among those who received radiation alone and 50% among those who underwent surgery alone. Rates ranged from 44% to 64% among those who received some form of radiation plus surgery.
Five-year OS was 0% among those who received radiation alone and 15% among those who underwent surgery alone. Rates ranged from 0% to 18% among those who received some form of radiation plus surgery.
“The variable nature of the rectal cancer disease burden makes it difficult to draw conclusions about patterns of care for metastatic rectal cancer in the United States,” the researchers wrote. “It appears that the inclusion of radiation therapy vs. surgery alone is more common in patients with rectal primary tumors, ... no lymph node involvement or lower T-classification disease. Furthermore, treatment regimens that included both radiation therapy and surgery demonstrate prolonged survival, particularly in patients with rectal disease.”
Disclosure: The researchers report no relevant financial disclosures.
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