Abstract
Total neoadjuvant therapy (TNT) has emerged as the preferred approach for locally
advanced rectal cancer (LARC), defined as T3/4 or any T with N+ disease. Our objective
was to (1) determine the proportion of patients with LARC receiving TNT over time,
(2) determine the most common method in which TNT is being delivered, and (3) determine
what factors are associated with a greater likelihood of receiving TNT in the United
States. Retrospective data was obtained from the National Cancer Database (NCDB) for
patients diagnosed with rectal cancer between 2016 and 2020. Patients were excluded
if they had M1 disease, T1-2 N0 disease, incomplete staging information, nonadenocarcinoma
histology, received RT to a nonrectum site, or received a nondefinitive RT dose. Data
were analyzed using linear regression, χ2 test, and binary logistic regression. Of the 26,375 patients included, most patients
were treated at an academic facility (94.6%). Five thousand three (19.0%) patients
received TNT, and 21,372 (81.0%) patients did not receive TNT. The proportion of patients
receiving TNT increased significantly over time, from 6.1% in 2016 to 34.6% in 2020
(slope = 7.36, 95% CI 4.58-10.15, R2 = 0.96, P = .040). The most common TNT regimen was multiagent chemotherapy followed by long-course
chemoradiation (73.2% of cases from 2016-2020). There was a significant increase in
utilization of short-course RT as part of TNT from 2.8% in 2016 to 13.7% in 2020 (slope = 2.74,
95% CI 0.37-5.11, R2 = 0.82, P = .035). Factors associated with a lower likelihood of TNT usage included age >65,
female gender, Black race, and T3 N0 disease. TNT use in the United States has increased
significantly from 2016-2020, with approximately 34.6% of patients with LARC receiving
TNT in 2020. The observed trend appears to be in line with the recent National Comprehensive
Cancer Network guidelines recommending TNT as the preferred approach.
Keywords
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Article info
Publication history
Published online: February 04, 2023
Accepted:
January 31,
2023
Received in revised form:
January 24,
2023
Received:
December 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
