Rates of Organ Preservation Have Increased for Most Patients With Rectal Cancer

In the United States, rectal cancer is increasingly being managed without the use of surgery, allowing for higher rates of organ preservation, according to a large study published in JAMA Oncology.

The data showed that, between 2006 and 2020, rates of organ preservation significantly increased among patients with stage IIA-IIC and IIIA-IIIC disease, but patients with stage I rectal cancer experienced a decline in organ preservation during that period.

For this study, researchers analyzed 2006-2020 data from the National Cancer Database for 175,545 patients with rectal adenocarcinoma who were managed with curative intent. Disease stage was unknown for 25.7% of patients, but 17.4% had stage I disease, 24.7% had stage IIA-IIC disease, and 32.1% had stage IIIA-IIIC disease.

The absolute annual proportion of organ preservation increased from 18.4% in 2006 to 28.2% in 2020 (P <.001), a 53% relative increase. There was an increase in patients undergoing chemotherapy and/or radiation without tumor resection, from 14.5% in 2006 to 26.4% in 2020, and a decrease in transanal local excisions, from 3.9% to 1.9%.

Among patients with stage IIA-IIC disease, the rate of organ preservation significantly increased, as the percentage of patients receiving chemotherapy or radiation without resection increased from 18.0% in 2006 to 31.8% in 2020 (P <.001).

Patients with stage IIIA-IIIC disease also had a significant increase in organ preservation. The percentage of patients undergoing chemotherapy or radiation without resection increased from 15.3% in 2006 to 28.8% in 2020 (P <.001).

A similar increase in organ preservation was seen in patients with unknown disease stage, according to the researchers.

On the other hand, patients with stage I disease had a decline in organ preservation (P <.001). They had an increase in the rate of proctectomies, from 73.6% in 2006 to 79.7% in 2020, but a 4.7 percentage point decrease in the rate of transanal local excisions.

The researchers called this finding “noteworthy because it coincided with multiple clinical trials that indicated that about half of the patients with stage I disease could achieve a complete pathologic response, and more than two-thirds of them could undergo organ preservation.”

For the 80,607 patients in the overall study population who received neoadjuvant therapy followed by tumor resection, the rate of pathologic complete response increased from 6.5% in 2006 to 18.8% in 2020 (P <.001).

“Despite the prominence of clinical treatment guidelines in influencing care delivery, wide variation in treatment strategies exist,” the researchers wrote. “The increasing trends toward organ preservation should spur international medical and surgical societies to collaborate with all of the relevant stakeholders to codify core outcome sets and care standards for rectal cancer care that incorporate organ preservation.”

Reference

Loria A, Tejani MA, Temple LK, et al. Practice patterns for organ preservation in US patients with rectal cancer, 2006-2020. JAMA Oncol. Published online November 9, 2023. doi:10.1001/jamaoncol.2023.4845

This article originally appeared on Cancer Therapy Advisor