Strahlentherapie und Onkologie

, Volume 186, Issue 1, pp 30–35 | Cite as

High-Grade Acute Organ Toxicity During Preoperative Radiochemotherapy as Positive Predictor for Complete Histopathologic Tumor Regression in Multimodal Treatment of Locally Advanced Rectal Cancer*

  • Hendrik Andreas Wolff
  • Jochen Gaedcke
  • Klaus Jung
  • Robert Michael Hermann
  • Hilka Rothe
  • Markus Schirmer
  • Torsten Liersch
  • Markus Karl Alfred Herrmann
  • Steffen Hennies
  • Margret Rave-Fränk
  • Clemens Friedrich Hess
  • Hans ChristiansenEmail author
Original Article


To test for a possible correlation between high-grade acute organ toxicity during preoperative radiochemotherapy and complete tumor regression after total mesorectal excision in multimodal treatment of locally advanced rectal cancer.

Patients and Methods:

From 2001 to 2008, 120 patients were treated. Preoperative treatment consisted of normofractionated radiotherapy at a total dose of 50.4 Gy, and either two cycles of 5-fluorouracil (5-FU) or two cycles of 5-FU and oxaliplatin. Toxicity during treatment was monitored weekly, and any toxicity CTC (Common Toxicity Criteria) ≥ grade 2 of enteritis, proctitis or cystitis was assessed as high-grade organ toxicity for later analysis. Complete histopathologic tumor regression (TRG4) was defined as the absence of any viable tumor cells.


A significant coherency between high-grade acute organ toxicity and complete histopathologic tumor regression was found, which was independent of other factors like the preoperative chemotherapy schedule. The probability of patients with acute organ toxicity ≥ grade 2 to achieve TRG4 after neoadjuvant treatment was more than three times higher than for patients without toxicity (odds ratio: 3.29, 95% confidence interval: [1.01, 10.96]).


Acute organ toxicity during preoperative radiochemotherapy in rectal cancer could be an early predictor of treatment response in terms of complete tumor regression. Its possible impact on local control and survival is under further prospective evaluation by the authors’ working group.

Key Words:

Rectal cancer Side effects Tumor regression Preoperative radiochemotherapy 

Höhergradige akute Organtoxizität während präoperativer Radiochemotherapie als positiver Prädiktor für komplette histopathologische Regression in der multimodalen Behandlung von lokal fortgeschrittenen Rektumkarzinomen


Überprüfung einer möglichen Korrelation zwischen höhergradiger akuter Organtoxizität während präoperativer Radiochemotherapie und kompletter Tumorregression nach totaler mesorektaler Exzision in der multimodalen Behandlung von lokal fortgeschrittenen Rektumkarzinomen.

Patienten und Methodik:

Im Zeitraum von 2001 bis 2008 wurden 120 Patienten behandelt. Die präoperative Behandlung bestand aus einer normofraktionierten Radiotherapie mit einer Gesamtdosis von 50,4 Gy und entweder zwei Zyklen 5-Fluorouracil (5-FU) oder zwei Zyklen 5-FU und Oxaliplatin. Die Toxizität während der Behandlung wurde wöchentlich untersucht. Jede Toxizität ≥ Grad 2 nach CTC (Common Toxicity Criteria) in Form von Enteritis, Proktitis oder Zystitis wurde dabei als höhergradige Organtoxizität gewertet und für spätere Analysen verwendet. Bei vollständigem histopathologischen Tumoransprechen (TRG4) konnten im Operationspräparat nach neoadjuvanter Therapie keine vitalen Tumorzellen mehr identifiziert werden.


Es fand sich eine signifikante Korrelation zwischen höhergradiger akuter Organtoxizität und kompletter Tumorregression, und zwar in multivariater Analyse unabhängig von anderen Faktoren wie z.B. dem präoperativen Chemotherapieregime. Die Wahrscheinlichkeit für die Patienten mit höhergradigen Nebenwirkungen, eine histopathologische Komplettremission zu entwickeln, war mehr als dreimal höher als für Patienten ohne Toxizität (Odds-Ratio: 3,29, 95%-Konfidenzintervall: [1,01, 10,96]).


Höhergradige akute Organtoxizität während präoperativer Radiochemotherapie bei Patienten mit multimodaler Therapie lokal fortgeschrittener Rektumkarzinome könnte einen frühen Prädiktor für das Ansprechen auf die Therapie in Bezug auf die histopathologische Remission darstellen. Ob dieser Parameter auch für die lokale Kontrolle sowie das Gesamtüberleben prädiktiv sein kann, wird in weiteren prospektiven Untersuchungen durch die Arbeitsgruppe der Autoren untersucht.


Rektumkarzinom Nebenwirkungen Tumorregression Präoperative Radiochemotherapie 


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Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  • Hendrik Andreas Wolff
    • 1
  • Jochen Gaedcke
    • 2
  • Klaus Jung
    • 3
  • Robert Michael Hermann
    • 1
    • 4
  • Hilka Rothe
    • 5
  • Markus Schirmer
    • 6
  • Torsten Liersch
    • 2
  • Markus Karl Alfred Herrmann
    • 1
  • Steffen Hennies
    • 1
  • Margret Rave-Fränk
    • 1
  • Clemens Friedrich Hess
    • 1
  • Hans Christiansen
    • 1
    • 7
    Email author
  1. 1.Department of Radiotherapy and RadiooncologyUniversity Medicine GöttingenGöttingenGermany
  2. 2.Department of SurgeryUniversity Medicine GöttingenGöttingenGermany
  3. 3.Department of Medical StatisticsUniversity Medicine GöttingenGöttingenGermany
  4. 4.Department of Radiotherapy and RadiooncologyÄrztehaus am DiakoBremenGermany
  5. 5.Department of PathologyUniversity Medicine GöttingenGöttingenGermany
  6. 6.Department of Clinical PharmacologyUniversity Medicine GöttingenGöttingenGermany
  7. 7.Universitätsmedizin GöttingenKlinik und Poliklinik für Strahlentherapie und RadioonkologieGöttingenGermany

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