Long-term survival after chemoradiotherapy without surgery for rectal adenocarcinoma : A word of caution
Menée aux Etats-Unis à partir des données 2004-2008 du registre national des cancers et d'un registre hospitalier portant sur 15 810 patients atteints d'un adénocarcinome rectal de stade II ou III, cette étude analyse, en fonction du traitement reçu (chimioradiothérapie en combinaison ou non avec une intervention chirurgicale), la survie globale à long terme des patients
Early studies with small samples from specialized centers report success with nonoperative management (NOM) or the watch-and-wait approach after neoadjuvant chemoradiotherapy for rectal adenocarcinoma. However, it is unknown whether the results are generalizable to the broader population of patients with rectal cancer. Still, use of chemoradiotherapy without surgery has doubled among individuals with nonmetastatic rectal adenocarcinoma. The highest use is observed among those who typically have lower access to innovative care: black patients, uninsured or Medicaid insured patients, and individuals treated at low-volume centers. We suspected that this treatment approach in the community setting may often represent a disparity in appropriate care rather than an innovative and intentional treatment strategy. The outcomes for patients who receive chemoradiotherapy only outside a clinical trial are unknown. We hypothesized that this approach is associated with worse overall survival (OS).
JAMA Oncology 2016