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Nonsurgical treatment of rectal cancer may result in worse outcomes
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Patients with stage II or stage III rectal cancer treated with chemoradiotherapy alone had worse OS outcomes than surgically treated patients, according to a research letter published in JAMA Oncology.
“Early studies with small samples from specialized centers report success with nonoperative management, or the watch-and-wait approach, after neoadjuvant chemoradiotherapy for rectal adenocarcinoma,” C. Tyler Ellis, MD, MSCR, general surgery resident at University of North Carolina at Chapel Hill, and colleagues wrote. “However, it is unknown whether the results are generalizable to the broader population of patients with rectal cancer. Still, the use of chemoradiotherapy without surgery has doubled among individuals with nonmetastatic rectal adenocarcinoma.”
Ellis and colleagues hypothesized that patients treated without surgery would have worse OS outcomes.
The researchers identified patients treated for stage II or III rectal adenocarcinoma in The National Cancer Data Base from January 2004 to December 2008. Patients received chemoradiotherapy alone or chemoradiotherapy followed by proctectomy.
Surgically treated patients experienced more favorable OS outcomes at 36 months (88.2% vs. 71.3%) and 60 months (77.1% vs. 58.2%) from diagnosis.
Patients who received chemoradiotherapy alone had worse outcomes at all points (HR = 1.9; 95% CI, 1.75-2.04). This persisted after the researchers adjusted for potential confounding factors, including race, insurance type or status, and treatment center volume (adjusted HR = 1.69; 95% CI, 1.59-1.84).
“From these data, we cannot know whether patients were receiving nonoperative management and had a complete response to chemoradiotherapy or whether patients failed to receive surgery for other reasons,” Ellis and colleagues wrote. “However, the results are concerning. As nonoperative management becomes an increasingly accepted treatment approach, more comparative effectiveness studies evaluating outcomes in the real-world setting will be needed.” – by Cameron Kelsall
Disclosure: One researcher reports funding from Bayer, Merck and Novartis. Ellis and the other researchers report no relevant financial disclosures.
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