Factors Associated With Receipt of Adjuvant Radiation in Locally Advanced Rectal Cancer.

Authors

Maryam Sherwani, Danish Ali, Hanjoo Lee, Alexander T Hawkins, Aimal Khan

Published in

Journal of surgical oncology. Sep 06, 2026. Epub Sep 06, 2026.

Abstract

Neoadjuvant radiotherapy (RT) has been the standard of care for locally advanced rectal cancer (LARC) for over two decades. Adjuvant RT use in LARC represents a deviation from standard care and warrants further investigation.
To identify factors associated with adjuvant RT utilization. We hypothesized that sociodemographic determinants contribute to differences in the sequence of radiation treatment among patients with rectal cancer.
This retrospective cohort study utilized the National Cancer Database (2015-2022) to identify adults with clinical stage II-III rectal adenocarcinoma undergoing surgery and RT. Patients were categorized by RT sequence (neoadjuvant vs. adjuvant). Multivariable logistic regression identified factors associated with use of adjuvant RT.
Of the included 48 452 patients, 6.9% received adjuvant RT. Compared with the neoadjuvant group, adjuvant RT recipients exhibited higher rates of pathologic upstaging (20.5% vs. 10.3%), positive margins (14.7% vs. 6.3%), and lymphovascular invasion (17.4% vs. 11.3%; all p < 0.001). On multivariable analysis, positive margins (aOR 1.78, 95% CI 1.43-2.22), lymphovascular invasion (aOR 1.96, 95% CI 1.66-2.31), upstaging (aOR 1.63, 1.31-2.02) were independently associated with adjuvant RT.
Adjuvant RT appeared to be used in patients who were found to have high-risk tumor pathology postoperatively.

PMID:
42702067
Bibliographic data and abstract were imported from PubMed on 07 Sep 2026.

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