Gender affects acute organ toxicity during radiochemotherapy for rectal cancer: Long-term results of the German CAO/ARO/AIO-94 phase III trial

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• 作者：Hendrik Andreas Wolff ; Lena-Christin Conradi ; Tim Beissbarth ; Andreas Leha ; Werner Hohenberger ; Susanne Merkel ; Rainer Fietkau ; Hans-Rudolf Raab ; J?rg Tschmelitsch ; Clemens Friedrich Hess ; Heinz Becker ; Christian Wittekind ; Rolf Sauer ; Claus R?del ; Torsten Liersch ; for the German Rectal Cancer Study Group
• 关键词：Rectal cancer ; Radiochemotherapy ; Multimodal treatment ; Gender ; Treatment associated toxicity
• 刊名：Radiotherapy and Oncology
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：108
• 期：1
• 页码：48-54
• 全文大小：380 K

文摘

Introduction

The CAO/ARO/AIO-94 phase-III-trial demonstrated a significant improvement of preoperative chemoradiotherapy (CRT) versus postoperative CRT on local control for UICC stage II/III rectal cancer patients, but no effect on long-term survival. In this add-on evaluation, we investigated the association of gender and age with acute toxicity and outcome.

Patients and methods

According to actual treatment analyses, 654 of 799 patients had received pre- (n = 406) or postoperative CRT (n = 248); in 145 patients postoperative CRT was not applied. Gender, age and clinicopathological parameters were correlated with CRT-associated acute toxicity and survival.

Results

The 10-year survival was higher in women than in men, with 72.4 % versus 65.6 % for time to recurrence (p = 0.088) and 62.7 % versus 58.4 % for overall-survival (OS) (p = 0.066), as expected. For patients receiving CRT, women showed higher hematologic (p < 0.001) and acute organ toxicity (p < 0.001) in the entire cohort as well as in subgroup analyses according to pre- (p = 0.016) and postoperative CRT (p < 0.001). Lowest OS was seen in patients without acute toxicity (p = 0.0271). Multivariate analyses for OS showed that acute organ toxicity (p = 0.034) was beneficial while age (p < 0.001) was associated with worse OS.

Discussion

Female gender is significantly associated with CRT-induced acute toxicity in rectal cancer. Acute toxicity during CRT may be associated with improved long-term outcome.