Attitudes Toward Pre-Operative Short-Course Radiation Therapy For Rectal Cancer Among Us Radiation Oncologists

Several landmark studies revealed short-course preoperative radiotherapy (SC-RT, 25 Gy in 5 fractions) followed by chemotherapy to be non-inferior to conventionally fractionated long-course chemoradiation therapy (CF-CRT). The current attitude towards these treatment modalities among US practicing radiation oncologists (ROs) is unknown. We surveyed US ROs via an anonymous online institutional review board-approved survey. Questions pertained to management preferences, knowledge of landmark randomized trials and hypothetical approach within the frame of an alternative reimbursement system. We received 220 responses. Fifty-eight percent of respondents (n=128) support SC-RT. Approximately 81% of respondents were familiar with the results of the randomized Trans-Tasman Radiation Group Trial 0104 and 51% with results of the randomized Polish Colorectal Study Group. There was no association between the knowledge of these studies and support for SC-RT (p-value = 0.726). The majority of respondents (72%) prefer to manage their patients with CF-CRT. The reasons cited for this preference were to achieve higher pathological complete response rate, to decrease toxicity and to achieve a better rate of sphincter preservation. If patient insisted on receiving SC-RT, 92% would feel comfortable. In a hypothetical situation where reimbursement would not be based on the number of fractions, 72% of respondents would still continue to prefer CF-CRT. Most ROs who would preferentially use SC-RT if insurance reimbursed at the same rate as CF-CRT also indicated they supported SC-RT compared to those who did not support SC-RT (85.2% vs 14.8%, p-value < 0.001). Despite several randomized trials showing SC-RT to be comparable to CF-CRT, 42% of US radiation oncologists do not support SC-RT and 72% prefer to manage their localized rectal cancer patients with CF-CRT. This does not appear to be influenced by the US radiation oncology reimbursement system.Abstract TU_6_2947; Table 1Reasons stated by survey respondents (n=220) leading to preferred utilization of CF-CRT over SC-RT.Stated Reasons for choosing CF-CRT over SC-RTn (%)*Better overall survival14 (8.9%)Better local control30 (19.0%)Higher pCR rate64 (40.5%)Better sphincter preservation64 (40.5%)Fewer acute toxicities29 (18.4%)Fewer long-term toxicities62 (39.2%)*Percentages do not add up to 100% as multiple reasons could be selected by respondents. Open table in a new tab