Journal of Radiation Oncology

, Volume 7, Issue 3, pp 213–222 | Cite as

Factors predictive of neoadjuvant versus adjuvant chemoradiotherapy in locally advanced rectal cancer and the impact on overall survival

  • Alex Coffman
  • Dustin Boothe
  • Jonathan Frandsen
  • Molly Gross
  • Thomas Bartley Pickron
  • Courtney L. Scaife
  • Shane Lloyd
Original Research



We investigated the effect of neoadjuvant versus adjuvant chemoradiotherapy on overall survival as well as the impact of demographic and clinical factors for the selection of each approach utilizing the National Cancer Data Base.


Adult patients with stage II and stage III adenocarcinoma of the rectum diagnosed from 2004 to 2013 were included. Chi-square analysis was used to compare demographic variables and clinical stage between the patients receiving neoadjuvant and adjuvant chemoradiotherapy. Univariate and multivariate logistic regression modeling was used to identify factors predictive of each treatment strategy. Kaplan-Meier and log-rank analysis and Cox proportional hazard modeling along with propensity score matching using variables known at the time of treatment sequence decision was performed to determine the effect on survival. A separate survival analysis was conducted including margin status to illustrate its effect on survival relative to adjuvant or neoadjuvant chemoradiation therapy.


A total of 20,114 patients were identified: 17,612 (87.6%) received neoadjuvant chemoradiotherapy. Factors associated with receipt of neoadjuvant chemoradiotherapy on multivariate analysis include the following: income greater than $46,000 (p < 0.01), treatment at an academic institution (p < 0.01), living greater than 50 miles from the treatment facility (p < 0.01), and year of diagnosis (p < 0.01). Compared to adjuvant chemoradiotherapy, neoadjuvant chemoradiotherapy was associated with a decreased risk of death on multivariate analysis (p = 0.05). When taking margin status into account, margin positivity in neoadjuvant chemoradiotherapy (NCRT) patients was shown to be a poor prognostic factor. Margin-negative NCRT patients had improved survival compared to margin negative adjuvant chemoradiotherapy (ACRT) patients.


The use of neoadjuvant chemoradiotherapy for locally advanced rectal cancer is possibly associated with an overall survival benefit compared to ACRT subject to the limitations of this analysis. Margin status affects survival greatly.


Rectal neoplasms Neoadjuvant therapy Survival Chemoradiation 



The authors would like to acknowledge Michelle Denney for help in preparing this manuscript for publication.

Compliance with ethical standards


No funding was received for this study.

Conflict of interest

Shane Lloyd declares personal fees from Sirtex. All the other authors declare no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

13566_2018_350_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Alex Coffman
    • 1
  • Dustin Boothe
    • 2
  • Jonathan Frandsen
    • 2
  • Molly Gross
    • 3
  • Thomas Bartley Pickron
    • 4
  • Courtney L. Scaife
    • 4
  • Shane Lloyd
    • 2
  1. 1.Department of Radiation OncologyLoma Linda University Medical CenterLoma LindaUSA
  2. 2.Department of Radiation Oncology, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA
  3. 3.The Iowa ClinicDes MoinesUSA
  4. 4.Department of Surgery, Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUSA

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