title: Acute small-bowel toxicity during neoadjuvant combined radiochemotherapy in locally advanced rectal cancer: determination of optimal dose-volume cut-off value predicting grade 2-3 diarrhoea.
abstract: BACKGROUND
  Current therapeutic standard for locally advanced rectal cancer is the neoadjuvant radiochemotherapy with total mesorectal excision. Diarrhoea is the main acute side effect, induced by the dose to the small-bowel, frequently leading to a treatment modification. Aim of this study was to analyse the differences between the irradiated small-bowel volumes and the occurrence of acute diarrhea during combined radiochemotherapy for rectal cancer.
  
  
  METHODS
  45 patients treated with a neoadjuvant radiochemotherapy (three-field box 50.4 Gy; Cetuximab, Capecitabine, Irinotecan) for locally advanced rectal cancer within a prospective phase I/II study were evaluated. Based on the dose-volume histograms, the small-bowel volumes receiving doses of 5, 10 … 45 Gy (V5, V10 …V45) were calculated and compared with the prospectively documented small- bowel toxicities.
  
  
  RESULTS
  There was a statistically significant difference between irradiated small-bowel volumes and the severity of therapy related diarrhoea. The strongest validity concerning the risk of developing a grade 2-3 diarrhoea was seen at a dose level of 5 Gy (V 5) with a small-bowel volume of 291.94 cc. Patients with V 5 > 291.94 cc had significantly more often grade 2-3 diarrhoea, than patients with V5 below this cut-off value (82% vs. 29%; p < 0.0001).
  
  
  CONCLUSIONS
  In the inverse treatment planning of rectal caner patients the small-bowel volume receiving 5 Gy should be limited to about 300 cc.
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. tina.reis@umm.de.
authors: Tina
authors: T
authors: Reis
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. edwinkhazzaka@gmx.de.
authors: Edwin
authors: E
authors: Khazzaka
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. Grit.Welzel@umm.de.
authors: Grit
authors: G
authors: Welzel
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. Frederik.Wenz@umm.de.
authors: Frederik
authors: F
authors: Wenz
authors: Medical Clinic, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany. Ralf.Hofheinz@umm.de.
authors: Ralf-Dieter
authors: RD
authors: Hofheinz
authors: Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. Sabine.Mai@umm.de.
authors: Sabine
authors: S
authors: Mai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D000069287:Capecitabine / Q000008:administration & dosage; D000068818:Cetuximab / Q000008:administration & dosage; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003967:Diarrhea / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012004:Rectal Neoplasms / Q000473:pathology / Q000628:therapy*
chemical_list: D000069287:Capecitabine; D000077146:Irinotecan; D000068818:Cetuximab; D002166:Camptothecin
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