Trends in intensity-modulated radiotherapy use for locally advanced rectal cancer at national comprehensive cancer network (NCCN) centers

• Published in: Advances in radiation oncology 2017
• Main Authors: Reyngold, Marsha, MD, PhD, Niland, Joyce, PhD, ter Veer, Anna, MS, Bekaii-Saab, Tanios, MD, Lai, Lily, MD, Meyer, Joshua E., MD, Nurkin, Steven J., MD, MS, Schrag, Deborah, MD, MPH, Skibber, John M., MD, FACS, Benson, Al B., MD, Weiser, Martin R., MD, Crane, Christopher H., MD, Goodman, Karyn A., MD, MS
• Format: Article
• Language: English
• Subjects: Hematology, Oncology, and Palliative Medicine
• ISSN: 2452-1094; 2452-1094
• DOI: 10.1016/j.adro.2017.10.001

Abstract Background Intensity-modulated radiotherapy (IMRT) has been rapidly incorporated into clinical practice due to technological advantages over three-dimensional conformal radiotherapy (3D-CRT). We characterized trends in IMRT utilization in trimodality treatment of locally advanced rectal cancer at NCCN cancer centers during 2005-2011. Patients and Materials Using the prospective NCCN Colorectal Cancer Database, we determined treatment patterns for 976 patients with stage II-III rectal cancer who received pelvic radiotherapy at contributing centers between 2005 and 2011. Multivariable logistic regression was used to identify factors associated with IMRT versus 3D-CRT. Radiotherapy compliance and time to completion were used to compare acute toxicity. Results Nine hundred forty-seven patients (97%) received 3D-CRT (80%) or IMRT (17%). Ninety-eight percent of these received radiotherapy pre-operatively; 81% underwent definitive resection. IMRT use increased from 30% in 2010 and thereafter, with significant variability between institutions (range, 0-43%). Other factors associated with IMRT use included age ≥65 years, dose >50.4 Gy, African-American race, and no transabdominal surgery. Rates of and time to radiotherapy completion were similar between groups. Conclusions While most stage II-III rectal cancer patients at queried NCI-designated cancer centers in 2005-2011 received 3D-CRT, significant and rising numbers received IMRT. IMRT utilization is highly variable among institutions and not uniform among sociodemographic groups, but may be more consistently embraced in specific clinical settings. Given this trend, comparative-effectiveness research is needed to evaluate the benefits of IMRT for rectal cancer.