Changes in the practice of adjuvant radiotherapy in resectable rectal cancer within a French well-defined population

Background and purpose: To assess the use of adjuvant radiotherapy in treating rectal cancers at a population level. Materials and methods: From 1976 to 1996, the influence of the period of diagnosis, sex, age, type of surgical resection, place of surgical resection on the use of radiotherapy was studied. A non-conditional logistic regression was performed to obtain the odds radio for each studied period adjusted for the other variables. Results: The use of adjuvant radiotherapy increased over time from 14.3% in 1976-1978 to 61.7% in 1994-1996 (odds ratio (OR): 28.0 for the 1994-1996 period compared with 1976-1978). It was also influenced by age (OR: 0.26 for patients >74 years compared with those <65 years), type of resection (OR: 3.42 for abdominoperineal resection compared with anterior resection) and place of surgery (OR: 0.39 for non-university hospitals compared with university hospitals). The nature of adjuvant radiotherapy altered over time: most adjuvant radiotherapy being done postoperatively before 1988, then preoperatively subsequently. Conclusions: Substantial changes have occurred in both the degree of use of adjuvant radiotherapy and in its timing. Some progress is still possible, in particular in older patients and in patients treated in non-university hospitals. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.