High-level evidence supports adjuvant radiotherapy for rectal cancer. We examined the influence of sociodemographic factors on patterns of adjuvant radiotherapy for resected Stage II/III rectal cancer. Methods. Patients undergoing surgical resection for stage II/III rectal cancer were identified in SEER registry. Results. A total of 21,683 patients were identified. Majority of patients were male (58.8%), white (83%), and with stage III (54.9%) and received radiotherapy (66%). On univariate analysis, male gender, stage III, younger age, year of diagnosis, and higher socioeconomic status (SES) were associated with radiotherapy. Radiotherapy was delivered in 84.4% of patients 50; however, only 32.8% of those are 80 years. Logistic regression demonstrated a significant increase in the use of radiotherapy in younger patients who are 50 (OR, 10.3), with stage III (OR, 1.21), males (OR, 1.18), and with higher SES. Conclusions. There is a failure to conform to standard adjuvant radiotherapy in one-third of patients, and this is associated with older age, stage II, area-level of socioeconomic deprivation, and female sex. 1. Introduction In contrast to colon cancer, transmural (T3 and T4) and node-positive rectal cancer has a propensity for local recurrence. Based on a significant morbidity of local-regional failure and evidence from prospective randomized trials demonstrating improvement in disease-free survival time and local-regional recurrences [1], the National Cancer Institute sponsored Consensus Conference convened in 1990 and recommended that postoperative chemoradiotherapy should be administered in all patients with stages II and III rectal cancers [2]. Despite these recommendations, adoption of these guidelines into clinical practice has been, at best, uneven [3–6]. There is little debate that chemoradiotherapy reduces local-regional failures and improves survival in stages II and III rectal cancer. The Swedish Rectal Cancer Trial randomized patients to preoperative radiotherapy versus surgery alone. The investigators demonstrated improved survival and local control rate in patients receiving a short-course high-dose preoperative radiotherapy [7]. The German Rectal Study Group [8] randomly assigned patients with clinical stages II and III rectal cancer to either preoperative or postoperative chemoradiotherapy, and they provided convincing evidence that preoperative chemoradiotherapy significantly improves the local recurrence rate than postoperative chemoradiotherapy. However, no difference in overall survival rate at 11 years of follow-up was observed
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