Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2017; 9(4): 97-102
Published online Apr 27, 2017. doi: 10.4240/wjgs.v9.i4.97
Trends with neoadjuvant radiotherapy and clinical staging for those with rectal malignancies
Sanjay S Reddy, Beth Handorf, Jeffrey M Farma, Elin R Sigurdson
Sanjay S Reddy, Jeffrey M Farma, Elin R Sigurdson, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
Beth Handorf, Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
Author contributions: Reddy SS designed, performed the research, and wrote the paper; Handorf B performed the statistical analysis; Farma JM and Sigurdson ER edited and supervised the project.
Institutional review board statement: This study was reviewed and approved by the institution.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that was obtained from a national cancer database.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: There is a potential risk of confidentiality loss during the study. The following steps will be taken to protect the confidentiality of the information obtained throughout the study: All protected information will be de-identified at the start of the research project; all original documents will be maintained on a computerized system in their original format. Data points will be maintained on a locked file in the office of Beth Handorf; only the investigators will have access to the electronic medical records; all investigators are HIPAA and NIH trained with regard to the protection of human research participants.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sanjay S Reddy, Assistant Professor, Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, United States.
Telephone: +1-201-2906739 Fax: +1-215-7282773
Received: September 30, 2016
Peer-review started: October 10, 2016
First decision: November 10, 2016
Revised: January 3, 2017
Accepted: February 18, 2017
Article in press: February 20, 2017
Published online: April 27, 2017

To see how patterns of care changed over time, and how institution type effected these decisions.


A retrospective analysis was performed using the National Cancer Database, looking at all patients that were diagnosed with rectal cancer from 1998 to 2011. We tested differences in rates of treatment and stage migration using χ2 tests and logistic regression models.


A review of ninety thousand five hundred and ninety four subjects underwent multimodality therapy for cancer of the rectum. Staging and response to treatment varied greatly between centers. Forty-six percent of the time staging was missing in academic practices, vs fifty-four percent of the time in community centers (P < 0.001). As a result, twenty-percent were down-staged and eight percent up-staged in academia, whereas only fifteen percent were down-staged and 8% up-staged in community practices (P < 0.001). Forty-two percent of individuals underwent radiation before surgery in 1998. Within two years this increased to fifty-three percent. This increased to eighty-six percent by 2011 (P < 0.001). Institution specific treatment varied greatly. Fifty-one percent received therapy before surgery in academic centers in 1998. Thirty-nine percent followed this pattern in the same year in the community (P < 0.001). By 2011, ninety-one percent received radiation before their procedure in academic centers, vs eighty-four percent in the community (P < 0.001). Rates of adoption were better in academia, although an increase was seen in both center types.


From the study dates of 1998 to 2011, preoperative treatment with radiation has been on the rise. There is certainly an increased rate of use of radiation in academia, however, this trend is also seen in the community. Practice patterns have evolved over time, although rates of assigning clinical stage are grossly underreported prior to initiation of preoperative therapy.

Keywords: Neoadjuvant therapy, Community, Rectal cancer, Academic

Core tip: This paper serves to show how changes in practice patterns evolve over time. The adoption of these practice patterns differ across institution type, and the role of appropriate clinical staging is often not included. In order for proper treatments to be initiated, we not only need data substantiated by level one evidence, but we also need proper clinical staging so we can ensure appropriate therapies are delivered to these patients.