TY  - JOUR
A1  - Lichthardt, Sven
A1  - Kerscher, Alexander
A1  - Dietz, Ulrich A.
A1  - Jurowich, Christian
A1  - Kunzmann, Volker
A1  - von Rahden, Burkhard H. A.
A1  - Germer, Christoph-Thomas
A1  - Wiegering, Armin
T1  - Original article: role of adjuvant chemotherapy in a perioperative chemotherapy regimen for gastric cancer
JF  - BMC Cancer
N2  - Background

Multimodal treatment strategies – perioperative chemotherapy (CTx) and radical surgery – are currently accepted as treatment standard for locally advanced gastric cancer. However, the role of adjuvant postoperative CTx (postCTx) in addition to neoadjuvant preoperative CTx (preCTx) in this setting remains controversial.

Methods

Between 4/2006 and 12/2013, 116 patients with locally advanced gastric cancer were treated with preCTx. 72 patients (62 %), in whom complete tumor resection (R0, subtotal/total gastrectomy with D2-lymphadenectomy) was achieved, were divided into two groups, one of which receiving adjuvant therapy (n = 52) and one without (n = 20). These groups were analyzed with regard to survival and exclusion criteria for adjuvant therapy.

Results

Postoperative complications, as well as their severity grade, did not correlate with fewer postCTx cycles administered (p = n.s.). Long-term survival was shorter in patients receiving postCTx in comparison to patients without postCTx, but did not show statistical significance. In per protocol analysis by excluding two patients with perioperative death, a shorter 3-year survival rate was observed in patients receiving postCTx compared to patients without postCTx (3-year survival: 71.2 % postCTx group vs. 90.0 % non-postCTx group; p = 0.038).

Conclusion

These results appear contradicting to the anticipated outcome. While speculative, they question the value of post-CTx. Prospectively randomized studies are needed to elucidate the role of postCTx.
KW  - gastric cancer
KW  - chemotherapy
KW  - neoadjuvant
KW  - multimodal
KW  - complication
KW  - adjuvant
KW  - risk factor
KW  - survival
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-147743
VL  - 16
IS  - 650
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  -