TY - THES A1 - Krämer, Karin T1 - Adjuvante Radiochemotherapie des Rektumkarzinoms - multizentrische retrospektive Analyse von 534 Patienten in Franken - Prognosefaktoren und adjuvante Therapieregime (B) - eine retrospektive Analyse des Krankenguts 6 fränkischer Strahlenkliniken im Zeitraum 4/93 bis 3/98 T1 - Adjuvant radiochemotherapy of rectal cancer - a multi-institutional retrospective quality control analysis of 534 patients - prognostic factors and adjuvant therapy regimes (B) - N2 - Die adjuvante Radiochemotherapie des Rektumkarzinoms im UICC-Stadium II/III wird seit 1991 von National Cancer Institute (NCI) und in Deutschland seit 1994 als Standard empfohlen. Die Qualität und Ergebnisse der postoperativen Therapie in der täglichen klinischen Praxis wurden flächendeckend retrospektiv untersucht. Insgesamt wurden 534 Patienten aus 6 Institutionen ausgewertet, die zwischen 1993 und 1998 behandelt wurden. Die beteiligten Kliniken versorgten strahlentherapeutisch flächendeckend große Teile des nordbayerischen Raumes. Die Stadienverteilung der Patienten war: UICC I 1%, II 28%, III 69% und IV 2%. 92% erhielten eine RChT, 8% eine alleinige RT. Die mediane Nachbeobachtungszeit der Patienten betrug 40 Monate. Ergebnisse (Teil B): Die Qualität der adjuvanten Therapie entsprach den gültigen Standards. Die lokale Kontrolle wurde in der multivariaten Analyse signifikant durch die pT- und pN-Kategorie, das Tumorgrading und eine RChT anstelle einer alleinigen RT beeinflusst. Bei 6% aller Patienten war nicht in sano, d.h. R1/R2 reseziert worden; bei 33% der pN0 kategorisierten Tumoren wurden weniger als die geforderten 12 Lymphknoten untersucht; beides führte zu einer signifikant reduzierten lokalen Kontrolle. Weitere Ergebnisse siehe Teil A. Schlussfolgerung: Der niedrige Anteil an der adjuvanten Therapie zugewiesenen Patienten sowie die im Vergleich zu randomisierten Studien ungünstigeren Ergebnisse weisen auf die Auswahl eines Risikokollektivs hin. Anstelle einer stadienbezogenen Zuweisung scheint eine Auswahl mit individueller Risikoabschätzung durch den Chirurgen bevorzugt zu werden. Neben Therapieverbesserungen durch randomisierte Studien sollten ebenso Anstrengungen zur Übertragung dieser Ergebnisse in die flächendeckende Praxis unternommen werden. N2 - Radiochemotherapy as adjuvant treatment for rectal cancer UICC stage II/III has been recommended by the National Cancer Institute (NCI) since 1991 and in Germany since 1994. Quality and results of postoperative treatment in day-to-day clinical practice in a complete region are evaluated retrospectively in a multi-institutional approach. 534 patients from six institutions treated between 1993 and 1998 were evaluated. The institutions covered a complete region with radiotherapeutic care. Patients were staged as follows: UICC I 1%, II 28%, III 69%, and IV 2%. 92% received RChT, 8% RT alone. Median follow-up of patients was 40 months. Results (part B): Quality of adjuvant treatment was well within a "corridor of adequate treatment". In multivariate analysis, local control was significantly influenced by T- and N-category, tumor grading, and RChT instead of RT alone. 6% of patients showed involved resection margins, in 33% of patients categorized pN0 less than the required 12 lymph nodes were examined, both leading to a significant decrease of local control. For further results see part A. Conclusion: While the quality of adjuvant treatment followed consensus guidelines, the number of referred patients which was lower than expected and the inferior treatment results as compared to randomized studies indicate that the consensus recommendations for adjuvant treatment have not been fully accepted. Instead of patient referral according to UICC stage, patient selection by the surgeons has been performed according to individual risk factors. Efforts have to be made not only to improve treatment results in randomized studies but also to transfer and control these standards in daily practice. KW - Rektumkarzinom KW - Adjuvante Therapie KW - Radiochemotherapie KW - Qualitätskontrolle KW - rectal cancer KW - adjuvant treatment KW - radiochemotherapy KW - patterns of care Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-7690 ER - TY - THES A1 - Aaken, Claas van T1 - Adjuvante Radiochemotherapie des Rektumkarzinoms - multizentrische retrospektive Analyse von 534 Patienten in Franken - Behandlungsergebnisse der Strahlentherapie und Evaluation (A) - eine retrospektive Analyse des Krankengutes 6 fränkischer Strahlenkliniken im Zeitraum 4/93 bis 3/98 T1 - Adjuvant radiochemotherapy of rectal cancer - a multi-institutional retrospective quality control analysis of 534 patients - results of radiotherapy and evaluation (A) - N2 - Die adjuvante Radiochemotherapie des Rektumkarzinoms im UICC-Stadium II/III wird seit 1991 vom National Cancer Institute (NCI) und in Deutschland seit 1994 als Standard empfohlen. Die Qualität und Ergebnisse der postoperativen Therapie in der täglichen klinischen Praxis wurden flächendeckend retrospektiv untersucht. Insgesamt wurden 534 Patienten aus sechs Institutionen ausgewertet, die zwischen 1993 und 1998 behandelt wurden. Die beteiligten Kliniken versorgten strahlentherapeutisch flächendeckend große Teile des nordbayerischen Raumes. Die Stadienverteilung der Patienten war: UICC I 1%, II 28%, III 69% und IV 2%. 92% erhielten eine RChT, 8% eine alleinige RT. Die mediane Nachbeobachtungszeit der Patienten betrug 40 Monate. Ergebnisse (Teil A): Nur etwa 37% der epidemiologisch erwarteten Patienten wurden entsprechend der Konsensusvereinbarung einer postoperativen Therapie zugewiesen. Nach 5 Jahren betrug die aktuarische lokale Kontrolle 75%, die Freiheit von Fernmetastasen 56%, das krankheitsfreie Überleben 53% und das Gesamtüberleben 57%. Weitere Ergebnisse siehe Teil B. Schlussfolgerung: Der niedrige Anteil von der adjuvanten Therapie zugewiesenen Patienten sowie die im Vergleich zu randomisierten Studien ungünstigeren Ergebnisse weisen auf die Auswahl eines Risikokollektivs hin. Anstelle einer stadienbezogenen Zuweisung scheint eine Auswahl mit individueller Risikoabschätzung bevorzugt zu werden. Neben Therapieverbesserungen durch randomisierte Studien sollten ebenso Anstrengungen zur Übertragung dieser Ergebnisse in die flächendeckende Praxis übernommen werden. N2 - Radiochemotherapy as adjuvant treatment for rectal cancer UICC stage II/III has been recommended by the National Cancer Institute (NCI) since 1991 and in Germany since 1994. Quality and results of postoperative treatment in day-to-day clinical practice in a complete region are evaluated retrospectively in a multi-institutional approach. 534 patients from six institutions treated between 1993 and 1998 were evaluated. The institutions covered a complete region with radiotherapeutic care. Patients were staged as follows: UICC I 1%, II 28%, III 69%, and IV 2%. 92% received RChT, 8% RT alone. Median follow-up of patients was 40 months. Results (Part A): Only about 37% of expected patients were referred for postoperative treatment. The 5-year actuarial rate was as follows: local control 75%, freedom from distant metastases 56%, disease-free survival 53%, and overall survival 57%. For further results see part B. Conclusion: While the quality of adjuvant treatment followed consensus guidelines, the number of referred patients which was lower as expected and the inferior treatment results as compared to randomized studies indicated that the consensus recommendations for adjuvant treatment have not been fully accepted. Instead of patient referral according to UICC stage, patient selection by the surgeons has been performed according to individual risk factors. Efforts have to be made not only to improve treatment results in randomized studies but also to transfer and control these standards in daily practice. KW - Rektumkarzinom KW - Adjuvante Behandlung KW - Radiochemotherapie KW - Qualitätskontrolle KW - rectal cancer KW - adjuvant treatment KW - radiochemotherapy KW - patterns of care Y1 - 2003 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-7681 ER - TY - THES A1 - Saur, Gabriella-Sofie T1 - Klinische Ergebnisse und Lebensqualität nach neoadjuvanter Radiochemotherapie von Rektumkarzinomen T1 - Clinical outcomes and life-qualiy after long-course radiochemotherapy for locally advanced rectal cancer N2 - Die derzeitige Standardtherapie bei fortgeschrittenen Rektumkarzinomen der UICC Stadien II und III besteht aus der neoadjuvanten Radio(chemo)therapie mit nachfolgender chirurgischer Intervention. Hierbei werden die beiden Therapiemodalitäten, der Kurzzeit-Radiotherapie(5x5Gy) und unmittelbare Operation von der Langzeit-Radiochemotherpaie (28x1,8Gy) mit einem Intervall von 4-6 Wochen bis zur Operation, unterschieden. Im Hinblick auf das Auftreten von Lokalrezidiven sowie auf das Gesamtüberleben sprechen die Ergebnisse für eine bessere Wirksamkeit der LZ-RChT. Dennoch gibt es klinische Situation, bei denen eine KZ-Radiotherapie sinnvoller sein kann. Somit kann als Konsequenz eine differenzierte Indikationsstellung für diese beiden Therapiemodalitäten abgeleitet werden. N2 - The standard therapy for local advanced rectal cancer in UICC stadium II and III consists of neoadjuvant radio(chemo)therapy followed by surgical intervention. In this connection the two therapy regiments on the one hand a short term radiotherapy (5x5 Gy) followed by surgery and on the other hand a long term radiotherapy (28x1,8 Gy) with a free interval of 4-6 weeks till surgery are differentiated. Looking at the frequency of local relapses and overall survival the results of the long term radiotherapy are superior to the results of short term radiotherapy. Nevertheless there are clinical situations in which the use of short term radiotherapy can be indicated. In consequence there has to be a well differentiated indication-defining process for choosing the right therapy. KW - Rektumkarzinom KW - Langzeitradiochemotherapie KW - Lebensqualität KW - rectal cancer KW - long-course radiochemotherapy KW - life-quality Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-78562 ER - TY - JOUR A1 - Kroeber, Jana A1 - Wenger, Barbara A1 - Schwegler, Manuela A1 - Daniel, Christoph A1 - Schmidt, Manfred A1 - Djuzenova, Cholpon S A1 - Polat, Bülent A1 - Flentje, Michael A1 - Fietkau, Rainer A1 - Distel, Luitpold V. T1 - Distinct increased outliers among 136 rectal cancer patients assessed by \(\gamma\)H2AX JF - Radiation Oncology N2 - Background: In recent years attention has focused on \(\gamma\)H2AX as a very sensitive double strand break indicator. It has been suggested that \(\gamma\)H2AX might be able to predict individual radiosensitivity. Our aim was to study the induction and repair of DNA double strand breaks labelled by \(\gamma\)H2AX in a large cohort. Methods: In a prospective study lymphocytes of 136 rectal cancer (RC) patients and 59 healthy individuals were ex vivo irradiated (IR) and initial DNA damage was compared to remaining DNA damage after 2 Gy and 24 hours repair time and preexisting DNA damage in unirradiated lymphocytes. Lymphocytes were immunostained with anti-\(\gamma\)H2AX antibodies and microscopic images with an extended depth of field were acquired. \(\gamma\)H2AX foci counting was performed using a semi-automatic image analysis software. Results: Distinct increased values of preexisting and remaining \(\gamma\)H2AX foci in the group of RC patients were found compared to the healthy individuals. Additionally there are clear differences within the groups and there are outliers in about 12% of the RC patients after ex vivo IR. Conclusions: The \(\gamma\)H2AX assay has the capability to identify a group of outliers which are most probably patients with increased radiosensitivity having the highest risk of suffering radiotherapy-related late sequelae. KW - histone H2AX KW - blood lymphocytes KW - in vivo KW - foci KW - individual radiosensitivity KW - rectal cancer KW - radiotherapy KW - DNA double strand breaks KW - phosphorylation KW - neck cancer KW - oral mucositis KW - DNA damage KW - radiosensitivity KW - repair KW - \(\gamma\)h2ax Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144085 VL - 10 IS - 36 ER - TY - THES A1 - Lövesz, Viola T1 - Postoperative Lebens- und Kontinenzqualität nach totaler mesorektaler Exzision bei Rektumkarzinom T1 - Quality of life and continence after total mesorectal excision for rectal cancer N2 - In der vorliegenden Arbeit wurde retrospektiv die Lebens- und Kontinenzqualität von Patienten, die aufgrund eines Rektumkarzinoms mittels totaler mesorektaler Exzision operiert wurden, erfasst. Ein Zusammenhang zwischen Lebens-und Kontinenzqualität wurde untersucht. Die Erhebung der Lebensqualität erfolgte mittels GIQLI (Gastrointestinal Quality of Life Index) und der Kontinenzqualität mit Hilfe des Wexner- und Cleveland Clinic Constipation-Score. Ergänzend dazu wurden Patientendaten erhoben und kombiniert mit den Antworten der Fragebögen ausgewertet. Postoperativ zeigte sich eine zunächst verminderte Lebensqualität, die sich über die Jahre wieder den Ergebnissen gesunder Probanden annäherte. Patienten mit einem im mittleren Rektumdrittel befindlichen Tumor erzielten bessere Ergebnisse im Lebensqualitätsbogen. Die Kontinenz war vor allem von der Art der Anastomose abhängig. Die Tumorlokalisation zeigte sich ohne große Einflussnahme auf die Kontinenzleistung. Die Rekonstruktion mittels J-Pouch oder Latero-terminaler Anastomose war der geraden Anastomosierung vorzuziehen. Postoperative Komplikationen traten vermehrt bei einem im unteren Rektumdrittel lokalisierten Tumor auf. Signifikant häufiger wurden Stenosen diagnostiziert. Eine gute Kontinenzleistung wirkte sich auf alle fünf Bereiche, die der GIQLI abfragt aus und korrelierte somit mit einem höheren Maß an Lebensqualität. N2 - The present study deals with the quality of life and continence regarding rectal cancer patients stare after mesorectal excision. It primarily focuses on the correlation between the given parameters. Methods used to showcase were the GIQLI (Gastrointestinal Quality of Life Index), Wexner- Score and Cleveland Clinic Constipation- Score. Patients answers and data were combined to achieve an objective view on the researched subject. The average result of the GIQLI showed a 20 % lower quality of life compared to examples given in literature of healthy people. The initial decrease of life quality was remissive over the following years up to the results of healthy people group. A tumor located in the mid part of the rectum had a lower negative impact on patients postoperative life quality. Regarding the continence the type of anastomosis is the most important predictor for postoperative function. J-Pouch and side-to-end-anastomosis achieved much better results compared to end-to-end-anastomosis. Tumors located in the lower part of rectum showcased increased amount of complications and significantly more often stenosis. High continence ability correlated with high level on the GIQLI and therefore an increased quality of life. KW - Mastdarmkrebs KW - Lebensqualität KW - Kontinenz KW - rectal cancer KW - quality of life Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202353 ER - TY - JOUR A1 - Diers, J. A1 - Wagner, J. A1 - Baum, P. A1 - Lichthardt, S. A1 - Kastner, C. A1 - Matthes, N. A1 - Matthes, H. A1 - Germer, C.‐T. A1 - Löb, S. A1 - Wiegering, A. T1 - Nationwide in‐hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany JF - BJS Open N2 - Background The impact of hospital volume after rectal cancer surgery is seldom investigated. This study aimed to analyse the impact of annual rectal cancer surgery cases per hospital on postoperative mortality and failure to rescue. Methods All patients diagnosed with rectal cancer and who had a rectal resection procedure code from 2012 to 2015 were identified from nationwide administrative hospital data. Hospitals were grouped into five quintiles according to caseload. The absolute number of patients, postoperative deaths and failure to rescue (defined as in‐hospital mortality after a documented postoperative complication) for severe postoperative complications were determined. Results Some 64 349 patients were identified. The overall in‐house mortality rate was 3·9 per cent. The crude in‐hospital mortality rate ranged from 5·3 per cent in very low‐volume hospitals to 2·6 per cent in very high‐volume centres, with a distinct trend between volume categories (P < 0·001). In multivariable logistic regression analysis using hospital volume as random effect, very high‐volume hospitals (53 interventions/year) had a risk‐adjusted odds ratio of 0·58 (95 per cent c.i. 0·47 to 0·73), compared with the baseline in‐house mortality rate in very low‐volume hospitals (6 interventions per year) (P < 0·001). The overall postoperative complication rate was comparable between different volume quintiles, but failure to rescue decreased significantly with increasing caseload (15·6 per cent after pulmonary embolism in the highest volume quintile versus 38 per cent in the lowest quintile; P = 0·010). Conclusion Patients who had rectal cancer surgery in high‐volume hospitals showed better outcomes and reduced failure to rescue rates for severe complications than those treated in low‐volume hospitals. KW - rectal resection KW - rectal cancer KW - mortality rate Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212878 VL - 4 IS - 2 SP - 310 EP - 319 ER - TY - THES A1 - Schollbach, Julia T1 - Korrelation der Expression von Indoleamine-2,3-Dioxygenase (IDO) und Subgruppen von Tumor-infiltrierenden Lymphozyten (TILs) in Adenokarzinomen des Rektums nach neoadjuvanter Radiochemotherapie T1 - Correlation of the expression of indoleamine-2,3-dioxygenase (IDO) and subgroups of tumor-infiltrating lymphocytes (TILs) in rectal cancer after neoadjuvant chemoradiation N2 - Hintergrund: Prognoseeinschätzung und Therapieplanung des kolorektalen Karzinoms richten sich nach traditionellen Klassifikationen und Staging-Systemen (TNM). Fraglich bleibt, ob diese die Komplexität der Tumorbiologie erfassen. Immunologische Parameter wie Tumor-infiltrierende Lymphozyten und Enzyme des Tryptophan-Stoffwechsels wie die Indoleamin-2,3-Dioxygenase (IDO) gewinnen zunehmend an Bedeutung. Hinsichtlich der prognostischen Wertigkeit einer IDO1-Expression in Malignomen und vor allem beim kolorektalen Karzinom herrscht Uneinigkeit. In Bezug auf neoadjuvant vorbehandelte Malignome gibt es bislang keine Untersuchungen. Ziel: Ziel der Arbeit war es, die prognostische Rolle einer IDO1-Expression und CD8-T-Zell-Infiltration in Tumorproben von Patienten mit einem lokal fortgeschrittenen Rektumkarzinom nach neoadjuvanter Radiochemotherapie zu evaluieren sowie die Korrelationen mit klinisch-pathologischen Parametern und den Einfluss auf das Überleben zu untersuchen. Material und Methoden: Evaluiert wurde die Expression von IDO1 und CD8 durch immunhistochemische Färbungen in 106 Tumorgewebeproben von Patienten nach neoadjuvanter Radiochemotherapie. Die Immuninfiltration wurde im Stroma, an der Invasionsfront und innerhalb der Tumorzellen betrachtet und mit retrospektiv erhobenen klinisch-pathologischen Parametern korreliert. Ergebnis: Der IDO1-Gesamtscore korrelierte positiv mit dem CD8+-Gesamtscore. Eine hohe IDO1- bzw. CD8-Infiltration stellten sich als unabhängige prognostischer Marker für ein verbessertes rezidivfreies Überleben bzw. Gesamtüberleben dar. Diskussion: Die Studie zeigt, dass die Analyse des lokalen Immunphänotyps ein hilfreiches Instrument sein kann, um Prognosen und Therapieansätze für Patienten mit lokal fortgeschrittenem Rektumkarzinom nach neoadjuvanter Radiochemotherapie besser abschätzen und langfristig an unterschiedlichen Immunprofilen orientieren zu können. N2 - Background: Prognosis and therapy for colorectal cancer are based on traditional classifications and staging systems (TNM). It remains questionable whether these capture the complexity of tumor biology. Immunological parameters such as tumor-infiltrating lymphocytes and enzymes of the tryptophan metabolism such as indoleamine-2,3-dioxygenase (IDO) are becoming increasingly important. There is still a disagreement about the prognostic value of IDO1 expression in malignancies. Objectives: In this study, we examined the prognostic role of indoleamine-2,3-Dioxygenase (IDO1) and infiltrating cytotoxic T lymphocytes (CD8+) in locally advanced rectal carcinomas after neoadjuvant chemoradiation. Material and methods: Expression of IDO1 and CD8+ was evaluated through immunohistochemistry in 106 archival tumor tissue samples from patients following neoadjuvant chemoradiation and radical resection. Results: A high IDO1- or CD8+-infiltration presented itself as an independent prognostic marker for an improved recurrence-free survival or overall survival. Conclusion: Analysis of the local CD8+ and IDO1-expression profile may be a helpful tool in predicting prognosis for patients with locally advanced rectal cancer following neoadjuvant chemoradiation. KW - CD8 KW - Rektumkarzinom KW - Tryptophanstoffwechsel KW - Indolamin-2,3-Dioxygenase KW - IDO KW - Indoleamine-2,3-dioxygenase KW - CD8-Lymphoyzten KW - kolorektales Karzinom KW - rectal cancer KW - lymphocytes KW - chemoradiation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234590 ER - TY - JOUR A1 - Zimmermann, Marcus A1 - Richter, Anne A1 - Weick, Stefan A1 - Exner, Florian A1 - Mantel, Frederick A1 - Diefenhardt, Markus A1 - Fokas, Emmanouil A1 - Kosmala, Rebekka A1 - Flentje, Michael A1 - Polat, Bülent T1 - Acute toxicities of patients with locally advanced rectal cancer treated with intensified chemoradiotherapy within the CAO/ARO/AIO-12 trial: comparing conventional versus VMAT planning at a single center JF - Scientific Reports N2 - In locally advanced rectal cancer (LARC) neoadjuvant chemoradiotherapy is regarded as standard treatment. We assessed acute toxicities in patients receiving conventional 3D-conformal radiotherapy (3D-RT) and correlated them with dosimetric parameters after re-planning with volumetric modulated arc therapy (VMAT). Patients were randomized within the multicenter CAO/ARO/AIO-12 trial and received 50.4 Gy in 28 fractions and simultaneous chemotherapy with fluorouracil and oxaliplatin. Organs at risk (OAR) were contoured in a standardized approach. Acute toxicities and dose volume histogram parameters of 3D-RT plans were compared to retrospectively calculated VMAT plans. From 08/2015 to 01/2018, 35 patients with LARC were treated at one study center. Thirty-four patients were analyzed of whom 1 (3%) was UICC stage II and 33 (97%) patients were UICC stage III. Grade 3 acute toxicities occurred in 5 patients (15%). Patients with acute grade 1 cystitis (n = 9) had significantly higher D\(_{mean}\) values for bladder (29.4 Gy vs. 25.2 Gy, p < 0.01) compared to patients without bladder toxicities. Acute diarrhea was associated with small bowel volume (grade 2: 870.1 ccm vs. grade 0–1: 647.3 ccm; p < 0.01) and with the irradiated volumes V5 to V50. Using VMAT planning, we could reduce mean doses and irradiated volumes for all OAR: D\(_{mean}\) bladder (21.9 Gy vs. 26.3 Gy, p < 0.01), small bowel volumes V5–V45 (p < 0.01), D\(_{mean}\) anal sphincter (34.6 Gy vs. 35.6 Gy, p < 0.01) and D\(_{mean}\) femoral heads (right 11.4 Gy vs. 25.9 Gy, left 12.5 Gy vs. 26.6 Gy, p < 0.01). Acute small bowel and bladder toxicities were dose and volume dependent. Dose and volume sparing for all OAR could be achieved through VMAT planning and might result in less acute toxicities. KW - radiotherapy KW - rectal cancer Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301255 VL - 12 ER - TY - JOUR A1 - Diefenhardt, Markus A1 - Martin, Daniel A1 - Ludmir, Ethan B. A1 - Fleischmann, Maximilian A1 - Hofheinz, Ralf-Dieter A1 - Ghadimi, Michael A1 - Kosmala, Rebekka A1 - Polat, Bülent A1 - Friede, Tim A1 - Minsky, Bruce D. A1 - Rödel, Claus A1 - Fokas, Emmanouil T1 - Development and validation of a predictive model for toxicity of neoadjuvant chemoradiotherapy in rectal cancer in the CAO/ARO/AIO-04 phase III trial JF - Cancers N2 - Background: There is a lack of predictive models to identify patients at risk of high neoadjuvant chemoradiotherapy (CRT)-related acute toxicity in rectal cancer. Patient and Methods: The CAO/ARO/AIO-04 trial was divided into a development (n = 831) and a validation (n = 405) cohort. Using a best subset selection approach, predictive models for grade 3–4 acute toxicity were calculated including clinicopathologic characteristics, pretreatment blood parameters, and baseline results of quality-of-life questionnaires and evaluated using the area under the ROC curve. The final model was internally and externally validated. Results: In the development cohort, 155 patients developed grade 3–4 toxicities due to CRT. In the final evaluation, 15 parameters were included in the logistic regression models using best-subset selection. BMI, gender, and emotional functioning remained significant for predicting toxicity, with a discrimination ability adjusted for overfitting of AUC 0.687. The odds of experiencing high-grade toxicity were 3.8 times higher in the intermediate and 6.4 times higher in the high-risk group (p < 0.001). Rates of toxicity (p = 0.001) and low treatment adherence (p = 0.007) remained significantly different in the validation cohort, whereas discrimination ability was not significantly worse (DeLong test 0.09). Conclusion: We developed and validated a predictive model for toxicity using gender, BMI, and emotional functioning. Such a model could help identify patients at risk for treatment-related high-grade toxicity to assist in treatment guidance and patient participation in shared decision making. KW - rectal cancer KW - toxicity KW - neoadjuvant KW - chemoradiotherapy KW - risk score Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288081 SN - 2072-6694 VL - 14 IS - 18 ER -