ArticleTranslational cancer research2026
A real-world cohort study reveals the treatment paradox of radiotherapy underuse despite its association with survival advantage.
Article in Translational cancer research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: While surgery remains the standard curative treatment for rectal cancer (RC), optimal management for elderly non-surgical RC (ENS-RC) patients is poorly defined. This study aimed to evaluate the real-world utilization and survival association of radiotherapy (RT) in this underserved population, for whom evidence from randomized trials is largely absent. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. To mitigate confounding and selection bias, survival associations were assessed using Kaplan-Meier analysis, multivariable Cox regression, and propensity score matching, supplemented by extensive subgroup and sensitivity analyses. Results: Among 20,951 elderly ENS-RC patients, 9,019 (43.0%) received RT. After rigorous adjustment for confounders via multivariable Cox regression, RT was consistently associated with improved survival [adjusted hazard ratio (HR) for overall survival (OS) =0.91; 95% confidence interval (CI): 0.87-0.94]. This finding was supported by propensity score matching, which yielded a matched median OS of 16 Conclusions: RT use is associated with a substantial survival benefit in elderly ENS-RC patients, yet it remains underutilized in real-world practice-particularly among the oldest individuals who may benefit most. These real-world findings highlight a potential gap between evidence and practice, suggesting that individualized assessment for RT and further prospective investigation are warranted in this population.
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