EP696 - Comparison of Palliative Treatments for Patients with Stage IV Rectal Cancer: A Retrospective Study from the National Cancer Database

Monday, May 12, 2025

10:31 AM – 10:36 AM PT

ePoster Presenter(s)

Nir Horesh, MD

Resident Physician
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Sameh H. Emile, MBBCh, MSc, MD, FACS

Project Scientist
Cleveland Clinic Florida
Cleveland Clinic Florida
Plantation , FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Zoe Garoufalia, MD (she/her/hers)

Colorectal Surgery Fellow
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MP

Michal Perets, MD

Clinical Fellow
Cleveland Clinic Florida
Weston, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MO

Marcus Oosenbrug, MD CM (he/him/his)

Clinical Associate
Cleveland Clinic Florida
Cleveland Clinic Florida
Weston, Florida, United States

Disclosure information not submitted.
VS

Victor Strassmann, MD, PhD

Associate
Cleveland Clinic Florida - Weston, FL
Sunny Isles Beach, Florida, United States

Disclosure information not submitted.

Senior Author(s)

Steven D. Wexner, MD, PhD (Hon), MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE

Emeritus Chair, Department of Colorectal Surgery
Cleveland Clinic Florida
Cleveland Clinic Lerner College of Medicine at Case Western Reserve University
Weston, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Nir Horesh, MD: This individual has no financial relationships with ineligible companies.

Sameh H. Emile, MBBCh, MSc, MD, FACS: This individual has no relevant relationships with ineligible companies.

Zoe Garoufalia, MD: This individual has no financial relationships with ineligible companies.

Michal Perets, MD: This individual has no financial relationships with ineligible companies.

Steven D. Wexner, MD, PhD (Hon), FACS, FRCS, FRCSI, MAMSE, MD, PhD (Hon): This individual has no relevant relationships with ineligible companies.

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Purpose/Background: Patients with stage IV rectal cancer often receive palliative care for symptom control and to improve quality of life. The impact of palliative measures, including chemotherapy, radiation therapy, and surgery, on survival remains poorly defined. This study aimed to identify the survival outcome of different palliative strategies in metastatic rectal cancer.

Methods/Interventions: Using the National Cancer Database (NCDB), we identified patients diagnosed with stage IV rectal cancer from 2004 to 2021 who received palliative treatment. Patients were categorized into three groups: those receiving palliative chemotherapy (Chemotherapy group), palliative radiation (Radiation group), and palliative surgery (Surgery group). The primary outcome was overall survival. Comparative analyses of demographic and clinical factors were conducted using chi-square tests, and survival was assessed using Cox proportional hazards models and Kaplan-Meier statistics.

Results/Outcomes: Overall, 7867 patients with stage IV rectal cancer treated with palliative care were included. Palliative chemotherapy (n=4278, 54.3%) was the most used palliative treatment, followed by radiation therapy (n=2236, 28.4%), and surgery (n=1353, 17.3%). Patients who received radiation therapy were significantly older (66.6 years, SD 14.1) than patients who received chemotherapy (61.2 years, SD 12.7) or underwent surgery (63.6 years, SD 13.6), respectively (p < 0.001). Differences in metastatic burden were also notable, as bone metastases (23.5% vs. 8.9% and 9.5%, p< 0.001) and brain metastases (4.9% vs. 1.4% and 1.7%, p< 0.001) were more often reported in patients who received radiation therapy. Patients treated with chemotherapy had a lower proportion of liver metastases (20.9%) compared to radiotherapy (31.8%) and surgery groups (32.9%) (p < 0.001). There was a trend of increased use of palliative chemotherapy over time, from 1.4% in 2004 to 11.5% in 2021 (Figure 1). Kaplan-Meier survival analysis showed that chemotherapy was significantly (p < 0.001) associated with the longest overall survival (median: 18.6 months; 95% CI: 17.97-19.25) compared to radiation therapy (9.4 months; 95% CI: 8.67-10.12) and surgery groups (11.4 months; 95% CI: 10.32-12.71). Both radiation therapy (HR 1.27, 95% CI 1.13-1.42, p< 0.001) and surgery (HR 1.22, 95% CI 1.07-1.39, p=0.003) were associated with a significantly higher hazard of death compared to chemotherapy.

Conclusion/Discussion: Palliative chemotherapy for stage IV rectal cancer was associated with better survival outcomes than radiation therapy and surgery. These findings suggest that chemotherapy should be the preferred palliative treatment approach, in appropriately selected patients.