A nationwide audit of the use of radiotherapy for rectal cancer in Italy

• Published in: Techniques in coloproctology Vol. 14; no. 3; pp. 229 - 235
• Main Authors: Gagliardi, G., Pucciarelli, S., Asteria, C. R., Infantino, A., Romano, G., Cola, B., De Nardi, P., Brulatti, M., Lambertini, M., Contessini-Avesani, E., Casula, G., Coco, C., D’Amico, D., Selvaggi, F. F., Eccher, C., D’Ambrosio, G., Galeotti, F., Jovine, E., Demma, I., Fianchini, A., Ambrosino, G., Casentino, L. M., Fiorino, M.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.09.2010; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Analysis of Variance; Colectomy - methods; Colorectal Surgery; Female; Follow-Up Studies; Gastroenterology; Health Care Surveys; Humans; Italy; Logistic Models; Male; Medical Audit - methods; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neoadjuvant Therapy; Neoplasm Invasiveness - pathology; Neoplasm Staging; Odds Ratio; Original Article; Proctology; Radiotherapy Dosage; Radiotherapy, Adjuvant; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Retrospective Studies; Risk Assessment; Surgery; Survival Analysis; Treatment Outcome; Italy; Adjuvant radiotherapy; Disparities; Neoadjuvant radiotherapy; Rectal cancer
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-010-0597-9

Background There is good evidence that radiotherapy is beneficial in advanced rectal cancer, but its application in Italy has not been investigated. Methods We conducted a nationwide survey among members of the Italian Society of Colo-Rectal Surgery (SICCR) on the use of radiation therapy for rectal cancer in the year 2005. Demographic, clinical and pathologic data were retrospectively collected with an online database. Italy was geographically divided into 3 regions: north, center and south which included the islands. Hospitals performing 30 or more surgeries per year were considered high volume. Factors related to radiotherapy delivery were identified with multivariate analysis. Results Of 108 centers, 44 (41%) responded to the audit. We collected data on 682 rectal cancer patients corresponding to 58% of rectal cancers operated by SICCR members in 2005. Radiotherapy was used in 307/682 (45.0%) patients. Preoperative radiotherapy was used in 236/682 (34.6%), postoperative radiotherapy in 71/682 (10.4%) cases and no radiotherapy in 375 (55.0%) cases. Of the 236 patients who underwent preoperative radiotherapy, only 24 (10.2%) received short-course radiotherapy, while 212 (89.8%) received long-course radiotherapy. Of the 339 stage II–III patients, 159 (47%) did not receive any radiotherapy. Radiotherapy was more frequently used in younger patients ( P  < 0.0001), in patients undergoing abdominoperineal resection (APR) ( P  < 0.01) and in the north and center of Italy ( P  < 0.001). Preoperative radiotherapy was more frequently used in younger patients ( P  < 0.001), in large volume centers ( P  < 0.05), in patients undergoing APR ( P  < 0.005) and in the north–center of Italy ( P  < 0.05). Conclusion Our study first identified a treatment disparity among different geographic Italian regions. A more systematic audit is needed to confirm these results and plan adequate interventions.