{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T10:28:10Z","timestamp":1793788090616,"version":"4.6.1"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neoadjuvant radiotherapy (RT) has been the standard of care for locally advanced rectal cancer (LARC) for over two decades. Adjuvant RT use in LARC represents a deviation from standard care and warrants further investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify factors associated with adjuvant RT utilization. We hypothesized that sociodemographic determinants contribute to differences in the sequence of radiation treatment among patients with rectal cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study utilized the National Cancer Database (2015\u20132022) to identify adults with clinical stage II\u2013III rectal adenocarcinoma undergoing surgery and RT. Patients were categorized by RT sequence (neoadjuvant vs. adjuvant). Multivariable logistic regression identified factors associated with use of adjuvant RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the included 48\u2009452 patients, 6.9% received adjuvant RT. Compared with the neoadjuvant group, adjuvant RT recipients exhibited higher rates of pathologic upstaging (20.5% vs. 10.3%), positive margins (14.7% vs. 6.3%), and lymphovascular invasion (17.4% vs. 11.3%; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). On multivariable analysis, positive margins (aOR 1.78, 95% CI 1.43\u20132.22), lymphovascular invasion (aOR 1.96, 95% CI 1.66\u20132.31), upstaging (aOR 1.63, 1.31\u20132.02) were independently associated with adjuvant RT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adjuvant RT appeared to be used in patients who were found to have high\u2010risk tumor pathology postoperatively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70365","type":"journal-article","created":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T18:40:11Z","timestamp":1788720011000},"page":"904-913","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Receipt of Adjuvant Radiation in Locally Advanced Rectal Cancer"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0925-1848","authenticated-orcid":false,"given":"Maryam","family":"Sherwani","sequence":"first","affiliation":[{"name":"Section of Surgical Sciences, Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danish","family":"Ali","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center at San Antoni San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0373-0784","authenticated-orcid":false,"given":"Hanjoo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery Division of Colon &amp; Rectal Surgery, Harbor\u2010UCLA Medical Center Torrance California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander T.","family":"Hawkins","sequence":"additional","affiliation":[{"name":"Section of Surgical Sciences, Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2851-8330","authenticated-orcid":false,"given":"Aimal","family":"Khan","sequence":"additional","affiliation":[{"name":"Section of Surgical Sciences, Vanderbilt University Medical Center Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"issue":"7","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/1097-0142(19831001)52:7<1317::AID-CNCR2820520731>3.0.CO;2-6","article-title":"Patterns of Recurrence of Rectal Cancer After Potentially Curative Surgery","volume":"52","author":"Rich T.","year":"1983","journal-title":"Cancer"},{"issue":"11","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1001\/jama.1990.03450110090034","article-title":"Adjuvant Therapy for Patients With Colon and Rectal Cancer","volume":"264","author":"NIH Consensus Conference","year":"1990","journal-title":"Journal of the American Medical Association"},{"issue":"14","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1056\/NEJM199704033361402","article-title":"Improved Survival With Preoperative Radiotherapy in Resectable Rectal Cancer","volume":"336","author":"Trial Swedish Rectal Cancer","year":"1997","journal-title":"New England Journal of Medicine"},{"issue":"5","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1046\/j.1463-1318.2003.00509.x","article-title":"Adjuvant vs. Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: The German Trial CAO\/ARO\/AIO\u201094","volume":"5","author":"Sauer R.","year":"2003","journal-title":"Colorectal Disease"},{"issue":"4","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1002\/jso.70025","article-title":"Adjuvant Radiotherapy in Incidental Positive Nodal Disease in Rectal Cancer\u2010A Systemic Review","volume":"132","author":"Thong D. 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