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UTILIZATION RATES OF NEOADJUVANT TREATMENT APPROACHES FOR RECTAL CANCER IN 3 HOSPITALS; RECENT INCREASE IN SHARE OF TNT AND SYSTEMIC CHEMOTHERAPY CASES AND DECREASED EMPLOYMENT OF RADIATION (RT).
Elizabeth Nilsson Sjolander
*1,2, Neil Mitra
1, Yi-Ru Chen
1, Nicholas La Gamma
2, Joseph Martz
1, David Rivadeneira
3, Marc Greenwald
2, Daniel A. King
2, Richard L. Whelan
11Lenox Hill Hospital, New York, NY; 2North Shore University Hospital, Manhasset, NY; 3Huntington Hospital, Northwell Health, Huntington, NY
Introduction: Over the past 1-2 decades there has been a notable increase in the percentage of rectal cancer (RC) patients receiving neoadjuvant treatment and the number of treatment approaches. Whereas RT, usually with concomitant 5 FU or capecitabine (RT/chemo), was the main approach for decades, systemic chemotherapy and total neoadjuvant treatment (TNT, systemic chemotherapy followed or proceeded by RT/chemo) are now commonly employed as a result of grade 1 evidence demonstrating efficacy. In an effort to determine the breakdown of neoadjuvant method use in the last 3 years, data from 3 separate hospitals within a single healthcare system, each with an NAPRC-approved tumor board (TB) (all rectal cancer patients presented), was analyzed.
Methods: Data from the 3 hospitals’ NAPRC TBs was entered into a single "system wide" REDCap database. Data from the initial TB presentation as well as the mandated post-neoadjuvant treatment TB presentation was assessed (from 2021 to 2024). Each hospital’s TB’s recommendations as well as the implementation rates of the different approaches were determined.
Results: 212 RC patients’ (pts) data was assessed. The overall distribution of tumors was as follows: distal, 62 pts (29%); middle, 89 pts (42%), and proximal, 61 pts (29%). The demographics and tumor locations of the pts at each hospital were similar. Overall, neoadjuvant treatment was recommended for 155 pts (69%), with 6% of these pts with clinical TNM stage that was T3 and N1 negative. The recommended treatment method breakdown was: Total neoadjuvant treatment,133 pts (86% of the pts getting neoadjuvant treatment); systemic chemotherapy alone, 11 pts (7%); RT (+/- concomitant chemo), 7 pts (5%). Similar neoadjuvant utilization patterns were noted for all 3 of the TBs. Of the pts receiving TNT, there were similar rates of RT then chemo (52%) versus chemo then RT/chemo (48%). The overall complete response (CR) rate was 23% of which the majority pursued a watch and wait approach; 5% of neoadjuvant pts had progression of disease and went on to palliative chemotherapy. Of the pts who went directly to surgery after TB presentation 51% had proximal RC’s, 31% middle rectal tumors and 18% distal lesions. LAR or proctectomy was done in 91% while 4% had transanal full thickness resection. Of those pts going to surgery minus neoadjuvant treatment, 94% had R-0 resections.
Conclusions: Not surprisingly, a large percentage of RC pts are getting neoadjuvant therapy. There has been a notable increase in the use of systemic chemo and TNT neoadjuvant coupled with a decrease in use of RT alone. This trend was seen at all 3 hospitals. RC treatment continues to evolve. Not surprisingly, the majority of those going to surgery directly had proximal lesions. NAPRC TBs, which by mandate track RC pts recommendations and treatment, are promising data sources.
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