Multimodality Treatment of T4 XXXX in the United States: Utilization Trends and Impact on Survival.

@entity1 @entity5 @entity356 @entity1349
BACKGROUND: National guidelines advocate use of multimodality therapy (MMT) for treatment of T4 @entity356 (T4GC). Prior studies demonstrate poor compliance with these guidelines. We sought to assess treatment trends and association between different treatment approaches and @entity1349 ( @entity1349 ) in a large cohort of U.S. METHODS: @entity1 diagnosed with clinical T4 @entity356 were selected from the National Cancer Data Base (1998-2011). Temporal trends, risk factors associated with failure to receive treatment, and effect of treatments on @entity1349 were assessed. RESULTS: Of 4369 @entity1 with T4GC, only 15 % (n = 652) received MMT. Treatment with MMT increased over time, and was utilized in 25 % of @entity1 after 2006. Older age, African American race, nonprivate insurance, proximal @entity5 location, and clinical node-negative disease were associated with failure to receive surgery; older age, female sex, poorly differentiated @entity5 grade, clinical node-negative disease, and prolonged postoperative length of stay were associated with failure to complete MMT in @entity1 who underwent surgical resection. Median @entity1349 was longest in @entity1 receiving MMT (19.2 months), and was similarly poor in @entity1 undergoing surgical resection (9.0 months) or nonsurgical therapy (8.3 months; p < 0.001). Median @entity1349 was longer in @entity1 receiving neoadjuvant therapy compared to @entity1 receiving adjuvant therapy (27.8 vs. 16.6 months; p = 0.004). CONCLUSIONS: Treatment with neoadjuvant MMT is increasing and is associated with prolonged survival. Surgery alone and chemotherapy with or without radiotherapy without resection are associated with similarly poor outcomes. Appropriate treatment sequencing may facilitate delivery of MMT and improve outcomes in @entity1 with T4GC.
