title: Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer.
abstract: OBJECTIVE
  Chemoradiotherapy (CRT) followed by surgery is the standard of care for locally advanced rectal cancer (LARC). For grade ⩾3 acute diarrhea there is a relationship between dose and irradiated small bowel volume. The aim of this study was to evaluate whether combined placement of a diverting stoma and sigmoid spacer (DSSS) led to reduced irradiated small bowel volume and less grade ⩾3 acute diarrhea in the treatment of LARC.
  
  
  METHODS
  Between 2003 and 2010, 54 of 189 LARC patients treated with CRT in two institutions had a DSSS prior to CRT. Data on patient and treatment characteristics and outcomes were collected retrospectively. Delineation of small bowel was performed with planning CT-scans. CTCAE version 4.0 was used for acute toxicity.
  
  
  RESULTS
  Patients with a DSSS had significantly less small bowel volume irradiated up to doses of 20Gy. This difference was not observed for the higher dose levels. CRT induced grade ⩾3 acute diarrhea was not different between the two groups (8.3% vs. 12.8%; p=0.41).
  
  
  CONCLUSIONS
  DSSS is not clearly beneficial to reduce grade ⩾3 acute diarrhea, and it must be considered whether placement of a DSSS is justified for this purpose.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
authors.forename: Jochem R N
authors.initials: JR
authors.lastname: van der Voort van Zyp
authors.affiliation: Department of Radiation Oncology, Radiotherapy Center West, The Hague, The Netherlands.
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Ceha
authors.affiliation: Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Valerie
authors.initials: V
authors.lastname: Niehe
authors.affiliation: Department of Surgery, Medical Center Haaglanden, The Hague, The Netherlands.
authors.forename: Andreas W K S
authors.initials: AW
authors.lastname: Marinelli
authors.affiliation: Department of Biomedical Statistics, Leiden University Medical Center, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Putter
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Center, The Netherlands. Electronic address: c.a.m.marijnen@lumc.nl.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012189:Retrospective Studies; D054047:Surgical Stomas; D014057:Tomography, X-Ray Computed
keywords: Chemoradiotherapy; Diverting stoma; Rectal cancer; Small bowel; Spacer; Toxicity