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Combined-modality Therapy for Rectal Cancer: Analysis of Potential Differences in Disease Presentation, Treatment Adherence, and Treatment Outcome According to Race

Tonlaar, Nathan MD*; Song, Suisui MD*; Hong, Julian C. MS; Minsky, Bruce D. MD*; Chang, Daniel T. MD; Polite, Blase N. MD; Liauw, Stanley L. MD*

American Journal of Clinical Oncology: April 2014 - Volume 37 - Issue 2 - p 122–125
doi: 10.1097/COC.0b013e318271ae2c
Original Articles: Gastrointestinal

Objectives: Population-based studies suggest African Americans (AAs) with rectal cancer have a worse overall outcome compared with non-AAs. This relationship was explored in a cohort of rectal cancer patients treated with preoperative chemoradiation therapy (CRT) and surgery at 2 academic cancer centers.

Methods: A total of 146 patients (26 AA, 120 non-AA) underwent treatment with curative intent. The median age was 57 years. Median dose was 50.4 Gy, given with 5-fluorouracil-based concurrent chemotherapy. Differences in disease presentation, adherence to recommended therapy, and treatment outcome (freedom from failure) by race were analyzed. Median follow-up was 34 months from completion of CRT.

Results: AAs had longer time from diagnosis to start of therapy (median, 45 vs. 35 d; P<0.01) and from CRT completion to surgery (median, 42 vs. 46 d; P=0.03). AA patients presented with more favorable disease (20% stage I, 33% stage III) compared with non-AA patients (0% stage I, 48% stage III, P<0.01). AA patients were less likely to receive adjuvant chemotherapy (58% vs. 89%, P=0.01). Log-rank analysis showed AAs were not more likely to recur after therapy (freedom from failure at 3 y, 100% for AA patients vs. 81% for non-AA patients, P=0.09). The difference in time from preoperative therapy to surgery and a lower rate of adjuvant therapy in AA patients did not seem to result in inferior disease outcome for this cohort.

Conclusions: Further study is necessary to explore the reasons underlying the delays in therapy and lower rates of adjuvant chemotherapy for AA patients.

Departments of *Radiation and Cellular Oncology

Medical Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL

Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA

B.D.M. is a consultant to Roche Pharmaceuticals, Varian Medical Systems, and Sanofi. The remaining authors declare no conflicts of interest.

Reprints: Stanley L. Liauw, MD, Department of Radiation and Cellular Oncology, Pritzker School of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL 60637. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc