EP938 - Rate Of Trimodal Therapy For Locally Advanced Rectal Adenocarcinoma After Establishment Of Institutional Protocol, Single Center Retrospective Analysis

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Purpose/Background: Trimodal Therapy, specifically Total Neoadjuvant Therapy (TNT), is the current gold-standard treatment for locally advanced rectal cancer (NCCN). Despite significant progress made in the past several decades, the care of rectal cancer in the United States is lacking due to significant variability in practice when compared to European counterparts, leading to the establishment of NAPRC. Wellspan York Hospital multidisciplinary rectal cancer consensus guideline was developed by the colorectal surgery group in 2018. Single center retrospective analysis was performed to evaluate the rate of Trimodal Therapy and TNT before and after the establishment of our institutional guideline to identify additional areas of improvement.

Methods/Interventions: Patients from the oncology department registry who underwent intervention by the colorectal surgery group between 2016 to 2021 were extracted for analysis. Inclusion criteria were patients with locally advanced rectal adenocarcinoma with location of tumor confirmed by colonoscopy or rectal MRI with tissue diagnosis by pathology. Exclusion criteria included patients with clinical stage 1 or 4 disease, patients deemed to be poor surgical candidates, recurrent disease, or undergoing treatment for concurrent cancer.

Results/Outcomes: Between 2016 to 2021, 107 patients with newly diagnosed locally advanced rectal cancer were identified who satisfied our inclusionary and exclusionary criteria. 30/107 patients did not ultimately undergo surgical intervention. Due to a protracted IRB process with expansion of the desired time range for inclusion of patients diagnosed in 2022, our analysis is not yet complete. Overall, there does not appear to be a significant difference in the rate of trimodal therapy offered before or after our institutional rectal cancer management guideline. Interestingly, the number of patients with locally advanced rectal cancer managed at our institution is on the rise and more patients are offered therapy in total neoadjuvant modality. We expect our data analysis to be complete by January, 2025.

Conclusion/Discussion: Upon initial analysis, there does not appear to be a consequential change in the rate of patients who received trimodal therapy when comparing data from before and after the institutional guidelines were put in place. However, as rates of colon and rectal cancers continue to increase amongst a younger population, developing set treatment guidelines and practices will become increasingly important. Limitations in this study include the number of patients excluded due to non operative intervention. Further data analysis will determine following study and practice guidelines.