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Adv Radiat Oncol. 2017 Oct 12;3(1):34-41. doi: 10.1016/j.adro.2017.10.001. eCollection 2018 Jan-Mar.

Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers.

Author information

1
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
2
Department of Information Sciences, City of Hope Comprehensive Cancer Center, Duarte, California.
3
Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California.
4
Division of Medical Oncology, Department of Medicine, The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
5
Department of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California.
6
Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
7
Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York.
8
Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.
9
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois.
11
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
12
Department of Radiation Oncology, University of Colorado Cancer Center, Aurora, Colorado.

Abstract

Purpose:

Intensity modulated radiation therapy (IMRT) has been rapidly incorporated into clinical practice because of its technological advantages over 3-dimensional conformal radiation therapy (CRT). We characterized trends in IMRT utilization in trimodality treatment of locally advanced rectal cancer at National Comprehensive Cancer Network cancer centers between 2005 and 2011.

Methods and materials:

Using the prospective National Comprehensive Cancer Network Colorectal Cancer Database, we determined treatment patterns for 976 patients with stage II-III rectal cancer who received pelvic radiation therapy at contributing centers between 2005 and 2011. Multivariable logistic regression was used to identify factors associated with IMRT versus 3-dimensional CRT. Radiation therapy compliance and time to completion were used to compare acute toxicity.

Results:

A total of 947 patients (97%) received 3-dimensional CRT (80%) or IMRT (17%). Ninety-eight percent of these patients received radiation therapy preoperatively, and 81% underwent definitive resection. IMRT use increased from <13% pre-2009 to >30% in 2010 and thereafter, with significant variability among 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 radiation therapy completion were similar between the groups.

Conclusions:

Although most patients with stage II-III rectal cancer at queried National Cancer Institute-designated cancer centers between 2005 and 2011 received 3-dimensional CRT, significant and increasing 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.

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