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

Marsha Reyngold, Joyce Niland, Anna ter Veer, Tanios Bekaii-Saab, Lily Lai, Joshua E. Meyer, Steven J. Nurkin, Deborah Schrag, John M. Skibber, Al B. Benson, Martin R. Weiser, Christopher H. Crane, Karyn A. Goodman

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalAdvances in Radiation Oncology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Rectal Neoplasms
Radiotherapy
Neoplasms
Comparative Effectiveness Research
African Americans

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers. / Reyngold, Marsha; Niland, Joyce; ter Veer, Anna; Bekaii-Saab, Tanios; Lai, Lily; Meyer, Joshua E.; Nurkin, Steven J.; Schrag, Deborah; Skibber, John M.; Benson, Al B.; Weiser, Martin R.; Crane, Christopher H.; Goodman, Karyn A.

In: Advances in Radiation Oncology, Vol. 3, No. 1, 01.01.2018, p. 34-41.

Research output: Contribution to journalArticle

Reyngold, M, Niland, J, ter Veer, A, Bekaii-Saab, T, Lai, L, Meyer, JE, Nurkin, SJ, Schrag, D, Skibber, JM, Benson, AB, Weiser, MR, Crane, CH & Goodman, KA 2018, 'Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers', Advances in Radiation Oncology, vol. 3, no. 1, pp. 34-41. https://doi.org/10.1016/j.adro.2017.10.001
Reyngold, Marsha ; Niland, Joyce ; ter Veer, Anna ; Bekaii-Saab, Tanios ; Lai, Lily ; Meyer, Joshua E. ; Nurkin, Steven J. ; Schrag, Deborah ; Skibber, John M. ; Benson, Al B. ; Weiser, Martin R. ; Crane, Christopher H. ; Goodman, Karyn A. / Trends in intensity modulated radiation therapy use for locally advanced rectal cancer at National Comprehensive Cancer Network centers. In: Advances in Radiation Oncology. 2018 ; Vol. 3, No. 1. pp. 34-41.
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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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AU - Niland, Joyce

AU - ter Veer, Anna

AU - Bekaii-Saab, Tanios

AU - Lai, Lily

AU - Meyer, Joshua E.

AU - Nurkin, Steven J.

AU - Schrag, Deborah

AU - Skibber, John M.

AU - Benson, Al B.

AU - Weiser, Martin R.

AU - Crane, Christopher H.

AU - Goodman, Karyn A.

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N2 - 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.

AB - 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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