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Peer-reviewedCC BY 4.0Journal of Surgical Oncology

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

  • Maryam Sherwani1
  • Danish Ali2
  • Hanjoo Lee3
  • Alexander T. Hawkins1
  • Aimal Khan1
  1. 1Section of Surgical Sciences, Vanderbilt University Medical Center Nashville Tennessee USA
  2. 2University of Texas Health Science Center at San Antoni San Antonio Texas USA
  3. 3Department of Surgery Division of Colon & Rectal Surgery, Harbor‐UCLA Medical Center Torrance California USA
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Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: Adjuvant RT appeared to be used in patients who were found to have high‐risk tumor pathology postoperatively.

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Cite

BibTeXRIS
BibTeX
@article{sherwani2026factors,
  title = {{Factors Associated With Receipt of Adjuvant Radiation in Locally Advanced Rectal Cancer}},
  author = {Maryam Sherwani and Danish Ali and Hanjoo Lee and Alexander T. Hawkins and Aimal Khan},
  journal = {Journal of Surgical Oncology},
  year = {2026},
  month = sep,
  doi = {10.1002/jso.70365},
  url = {https://doi.org/10.1002/jso.70365},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Factors Associated With Receipt of Adjuvant Radiation in Locally Advanced Rectal Cancer
AU  - Maryam Sherwani
AU  - Danish Ali
AU  - Hanjoo Lee
AU  - Alexander T. Hawkins
AU  - Aimal Khan
PY  - 2026
DA  - 2026/09/06
JO  - Journal of Surgical Oncology
DO  - 10.1002/jso.70365
UR  - https://doi.org/10.1002/jso.70365
AB  - Background: 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.  Objectives: 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.  Methods: 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.  Results: 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.  Conclusions: Adjuvant RT appeared to be used in patients who were found to have high‐risk tumor pathology postoperatively.
SN  - 0022-4790
SN  - 1096-9098
ER  -