Trends in adoption of total neoadjuvant therapy for locally advanced rectal cancer

Total neoadjuvant chemoradiation (TNT), an accepted strategy for the treatment of locally advanced rectal cancer (LARC), was first included in guidelines in 2018. We aimed to describe trends in, and factors associated with TNT receipt. A retrospective cohort study of adult patients with LARC was performed using the national cancer database (2012–2020). TNT status was determined, and temporal trends analyzed. Factors associated with TNT receipt were identified by stage. A total of 51,407 patients were identified; 57.3 % received TNT. Increasing age and comorbidities were associated with higher rates of TNT receipt. Patients with stage III disease were more likely to receive TNT (stage II OR 0.92, 95%CI 0.88–0.96). Patients were 38 % more likely to get TNT after guideline inclusion (OR1.38, 95%CI 1.31–1.46). Rates of TNT were consistently above 50 % and rose after inclusion in the NCCN guidelines. This study establishes baseline patterns in rates of TNT for future benchmarking. [Display omitted] •Total neoadjuvant chemoradiation (TNT) is being increasingly used to treat locally advanced rectal cancer.•TNT was first included in National Comprehensive Cancer Network (NCCN) guidelines in 2018.•New treatments are often slowly adopted into practice, even if supported by high quality evidence.•Baseline trends in treatment patterns must be established to identify gaps in use of the newest strategies.