Theodore S Hong, Jennifer L Pretz, Joseph M Herman, May Abdel-Wahab, Nilofer Azad, A William Blackstock, Prajnan Das, Karyn A Goodman, Salma K Jabbour, William E Jones, Andre A Konski, Albert C Koong, Miguel Rodriguez-Bigas, William Small, Charles R Thomas, Jennifer Zook, W Warren Suh
The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
{"title":"ACR Appropriateness Criteria®-Anal Cancer.","authors":"Theodore S Hong, Jennifer L Pretz, Joseph M Herman, May Abdel-Wahab, Nilofer Azad, A William Blackstock, Prajnan Das, Karyn A Goodman, Salma K Jabbour, William E Jones, Andre A Konski, Albert C Koong, Miguel Rodriguez-Bigas, William Small, Charles R Thomas, Jennifer Zook, W Warren Suh","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The management of anal cancer is driven by randomized and nonrandomized clinical trials. However, trials may present conflicting conclusions. Furthermore, different clinical situations may not be addressed in certain trials because of eligibility inclusion criteria. Although prospective studies point to the use of definitive 5-fluorouracil and mitomycin C-based chemoradiation as a standard, some areas remain that are not well defined. In particular, management of very early stage disease, radiation dose, and the use of intensity-modulated radiation therapy remain unaddressed by phase III studies. The American College of Radiology (ACR) Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. </p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924766/pdf/gcr4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32145580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Upcoming articles.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924765/pdf/gcr38.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32143472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexander N Shoushtari, Anne M Covey, Ghazi Zaatari, Ali Shamseddine, Andrew S Epstein, Ali Haydar, Mohamed Naghy, Deborah Mukherji, David P Kelsen, Ghassan K Abou-Alfa, Eileen M O'Reilly
{"title":"A woman with metastatic pancreatic neuroendocrine tumor.","authors":"Alexander N Shoushtari, Anne M Covey, Ghazi Zaatari, Ali Shamseddine, Andrew S Epstein, Ali Haydar, Mohamed Naghy, Deborah Mukherji, David P Kelsen, Ghassan K Abou-Alfa, Eileen M O'Reilly","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924762/pdf/gcr27.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32143470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shounak Majumder, Bhavtosh Dedania, Houman Rezaizadeh, Thomas Joyal, Michael Einstein
{"title":"Tumor rupture as the initial manifestation of primary hepatic leiomyosarcoma.","authors":"Shounak Majumder, Bhavtosh Dedania, Houman Rezaizadeh, Thomas Joyal, Michael Einstein","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924763/pdf/gcr33.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32143471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intrahepatic cholangiocarcinoma: are we doing the right thing?","authors":"Basile Njei","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924760/pdf/gcr1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32145579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shalini Sree Kumar, Timothy J Price, Omar Mohyieldin, Matthew Borg, Amanda Townsend, Jennifer E Hardingham
Background: The treatment of metastatic colorectal cancer (mCRC) includes drugs targeting the epidermal growth factor receptor (EGFR). Mutation in codon 12 or 13 in the Kirsten rat sarcoma viral oncogene homolog (KRAS) gene, downstream of the EGFR, evokes constitutive activation of the RAS/RAF/MAPK signaling pathway and correlates with resistance to anti-EGFR monoclonal antibody (mAb) therapies. However, a retrospective study reported that a proportion of patients with the KRAS G13D mutation may respond to cetuximab. A similar analysis for panitumumab was not as conclusive. We sought to determine the sensitivity of CRC cell lines to cetuximab or panitumumab treatment and to investigate the correlation of the KRAS mutational status of the CRC cell lines to the responsiveness to cetuximab or panitumumab.
Methods: To determine the responsiveness of CRC cell lines to cetuximab or panitumumab, cell lines were treated with an optimized concentration of each mAb, and proliferation assays were conducted.
Results: After treatment with cetuximab or panitumumab, at the optimum concentration of 8 μg/well, the KRAS G13D mutant cell lines HCT-116, LoVo, and T84 showed intermediate sensitivity to both treatments, between the resistant KRAS G12V mutant cell line SW480 and the sensitive KRAS wild-type cell line LIM1215. One of the G13D cell lines was significantly more sensitive to panitumumab than to cetuximab (P = .02).
Conclusion: The specific KRAS mutation determines the responsiveness to anti-EGFR monoclonal antibody treatment, corresponding to reported clinical observations.
{"title":"KRAS G13D Mutation and Sensitivity to Cetuximab or Panitumumab in a Colorectal Cancer Cell Line Model.","authors":"Shalini Sree Kumar, Timothy J Price, Omar Mohyieldin, Matthew Borg, Amanda Townsend, Jennifer E Hardingham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The treatment of metastatic colorectal cancer (mCRC) includes drugs targeting the epidermal growth factor receptor (EGFR). Mutation in codon 12 or 13 in the Kirsten rat sarcoma viral oncogene homolog (KRAS) gene, downstream of the EGFR, evokes constitutive activation of the RAS/RAF/MAPK signaling pathway and correlates with resistance to anti-EGFR monoclonal antibody (mAb) therapies. However, a retrospective study reported that a proportion of patients with the KRAS G13D mutation may respond to cetuximab. A similar analysis for panitumumab was not as conclusive. We sought to determine the sensitivity of CRC cell lines to cetuximab or panitumumab treatment and to investigate the correlation of the KRAS mutational status of the CRC cell lines to the responsiveness to cetuximab or panitumumab.</p><p><strong>Methods: </strong>To determine the responsiveness of CRC cell lines to cetuximab or panitumumab, cell lines were treated with an optimized concentration of each mAb, and proliferation assays were conducted.</p><p><strong>Results: </strong>After treatment with cetuximab or panitumumab, at the optimum concentration of 8 μg/well, the KRAS G13D mutant cell lines HCT-116, LoVo, and T84 showed intermediate sensitivity to both treatments, between the resistant KRAS G12V mutant cell line SW480 and the sensitive KRAS wild-type cell line LIM1215. One of the G13D cell lines was significantly more sensitive to panitumumab than to cetuximab (P = .02).</p><p><strong>Conclusion: </strong>The specific KRAS mutation determines the responsiveness to anti-EGFR monoclonal antibody treatment, corresponding to reported clinical observations.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930148/pdf/gcr23.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32143469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samhita Chakraborty, Monica M Morris, Todd W Bauer, Reid B Adams, Edward B Stelow, Gina Petroni, Hanna K Sanoff
Background: A standard neoadjuvant regimen has not been defined for borderline resectable (BR) pancreatic cancer. This phase II trial was designed to determine the safety of accelerated fraction radiotherapy (AFRT) with capecitabine in patients with BR pancreatic cancer.
Methods: The patients had newly diagnosed BR adenocarcinoma of the pancreas and normal organ function. Intensity-modulated (n = 11) or 3D conformal (n = 2) radiotherapy was given to a dose of 50 Gy in 2.5-Gy fractions with capecitabine 825 mg/m(2) twice on radiation days. The primary outcome was the frequency of severe treatment-related adverse events (AEs). The study was stopped before planned interim analysis because of 2 severe (grades 4 and 5) gastric ulcerations.
Results: Thirteen patients were enrolled with a median age of 66 years. All patients completed treatment. Seven (54%) experienced grade 3+ treatment-related AEs. Severe gastric ulceration occurred in 2 patients despite receipt of ≥43 Gy to only 1% (2-3 cm(3)) of the stomach. Lymphopenia (n = 7) was the only other severe AE that occurred in >1 patient. In 7 of the 13 patients, disease had progressed outside the pancreas at restaging. Five of the 13 underwent resection, and all had >10% viable tumor. Median progression-free survival (PFS) was 2.4 months (95% CI 1.9-5.9), and median survival was 9.1 months (95% CI 5.9-not reached). Among those who underwent resection, median PFS was 13.0 months (95% CI 4.4-not reached). Median survival was not reached.
Conclusions: Given the limited efficacy signal and severe gastric ulcerations, we do not recommend this regimen for pancreatic cancer. We also do not recommend the use of high doses per fraction outside a clinical trial.
背景:边缘性可切除(BR)胰腺癌的标准新辅助治疗方案尚未确定。这项II期试验旨在确定卡培他滨加速分段放疗(AFRT)在BR胰腺癌患者中的安全性。方法:新诊断的胰腺BR腺癌患者,脏器功能正常。调强放疗(n = 11)或三维适形放疗(n = 2),剂量为50 Gy,每组2.5 Gy,卡培他滨825 mg/m(2),放疗日两次。主要结局是严重治疗相关不良事件(ae)的发生频率。由于2例严重(4级和5级)胃溃疡,该研究在计划的中期分析之前停止。结果:13例患者入组,中位年龄66岁。所有患者均完成治疗。7例(54%)经历3+级治疗相关ae。2例患者在接受≥43 Gy照射后,仅1% (2-3 cm)的胃发生严重胃溃疡。淋巴细胞减少(n = 7)是发生在>1例患者中的唯一其他严重AE。13例患者中有7例在复发时疾病已进展到胰腺外。13例患者中有5例接受了手术切除,所有患者的肿瘤存活率均大于10%。中位无进展生存期(PFS)为2.4个月(95% CI 1.9-5.9),中位生存期为9.1个月(95% CI 5.9-未达到)。在接受切除术的患者中,中位PFS为13.0个月(95% CI 4.4-未达到)。中位生存期未达到。结论:鉴于有限的疗效信号和严重的胃溃疡,我们不推荐这种方案用于胰腺癌。我们也不建议在临床试验之外使用高剂量的每部分。
{"title":"Accelerated fraction radiotherapy with capecitabine as neoadjuvant therapy for borderline resectable pancreatic cancer.","authors":"Samhita Chakraborty, Monica M Morris, Todd W Bauer, Reid B Adams, Edward B Stelow, Gina Petroni, Hanna K Sanoff","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>A standard neoadjuvant regimen has not been defined for borderline resectable (BR) pancreatic cancer. This phase II trial was designed to determine the safety of accelerated fraction radiotherapy (AFRT) with capecitabine in patients with BR pancreatic cancer.</p><p><strong>Methods: </strong>The patients had newly diagnosed BR adenocarcinoma of the pancreas and normal organ function. Intensity-modulated (n = 11) or 3D conformal (n = 2) radiotherapy was given to a dose of 50 Gy in 2.5-Gy fractions with capecitabine 825 mg/m(2) twice on radiation days. The primary outcome was the frequency of severe treatment-related adverse events (AEs). The study was stopped before planned interim analysis because of 2 severe (grades 4 and 5) gastric ulcerations.</p><p><strong>Results: </strong>Thirteen patients were enrolled with a median age of 66 years. All patients completed treatment. Seven (54%) experienced grade 3+ treatment-related AEs. Severe gastric ulceration occurred in 2 patients despite receipt of ≥43 Gy to only 1% (2-3 cm(3)) of the stomach. Lymphopenia (n = 7) was the only other severe AE that occurred in >1 patient. In 7 of the 13 patients, disease had progressed outside the pancreas at restaging. Five of the 13 underwent resection, and all had >10% viable tumor. Median progression-free survival (PFS) was 2.4 months (95% CI 1.9-5.9), and median survival was 9.1 months (95% CI 5.9-not reached). Among those who underwent resection, median PFS was 13.0 months (95% CI 4.4-not reached). Median survival was not reached.</p><p><strong>Conclusions: </strong>Given the limited efficacy signal and severe gastric ulcerations, we do not recommend this regimen for pancreatic cancer. We also do not recommend the use of high doses per fraction outside a clinical trial.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924761/pdf/gcr15.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32145581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-10-01DOI: 10.1016/J.IJROBP.2013.06.782
S. Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee
{"title":"Benefit of Adjuvant Chemoradiotherapy for Gastric Adenocarcinoma: A SEER Population Analysis.","authors":"S. Seyedin, Pin-Chieh Wang, Quan Zhang, Percy Lee","doi":"10.1016/J.IJROBP.2013.06.782","DOIUrl":"https://doi.org/10.1016/J.IJROBP.2013.06.782","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78560430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rodrigo Kraft Rovere, Maria Eduarda Pires de Souza, Sara Fernanda Hilgert, Yasmine Rodrigues Chamse Ddine, Adma Silva de Lima
{"title":"Melanoma metastasis to the gastric mucosa preceded by guillain-barré as a paraneoplastic syndrome.","authors":"Rodrigo Kraft Rovere, Maria Eduarda Pires de Souza, Sara Fernanda Hilgert, Yasmine Rodrigues Chamse Ddine, Adma Silva de Lima","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849897/pdf/gcr150.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31932677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T Jonathan Yang, Jung Hun Oh, Christina H Son, Aditya Apte, Joseph O Deasy, Abraham Wu, Karyn A Goodman
Background: This study was conducted to identify the factors associated with acute gastrointestinal (GI) toxicity during pelvic chemoradiotherapy (PCRT) in patients with rectal cancer.
Methods: We analyzed 177 patients with rectal cancer treated from 2007 through 2010. Clinical information, including weekly diarrhea and proctitis toxicity grade during PCRT, was recorded. GI structures including bowel and anal canal were contoured. The associations between toxicity and clinical and dosimetric predictors were tested.
Results: The median age was 60; 76 patients were women; 98 were treated with intensity-modulated radiotherapy (IMRT) and 79 with 3D conformal RT (3DCRT). A higher rate of grade 2+ diarrhea was observed in the women, starting at week 4 (24% women vs. 11% men, P = .01; week 5: 33% vs. 12%, P = .002), as well as in all the patients treated with 3DCRT (22% vs. 12% IMRT, P = .03; week 5: 32% vs. 11%, P = .001). On multivariate analysis, the normal tissue complication probability (NTCP) model including bowel V45 (bowel volume receiving ≥45 Gy) showed that being female, and use of 3DCRT, was most predictive of grade 2+ diarrhea (area under the curve [AUC] = 0.76; R S = 0.35; P < .001). A higher rate of grade 2+ proctitis was seen in patients <60 years of age starting at week 3 (21% vs. 9%, P = .02; week 4: 35% vs. 16%, P = .003). The NTCP model including anal canal V15 and younger age was most predictive of grade 2+ proctitis (AUC = 0.67; R S = 0.25; P < .001).
Conclusions: Women and all patients who were treated with 3DCRT had higher rates of grade 2+ diarrhea, and the younger patients had a higher rate of grade 2+ proctitis during PCRT. The use of more stringent dosimetric constraints in higher risk patients is a strategy for minimizing toxicity.
{"title":"Predictors of acute gastrointestinal toxicity during pelvic chemoradiotherapy in patients with rectal cancer.","authors":"T Jonathan Yang, Jung Hun Oh, Christina H Son, Aditya Apte, Joseph O Deasy, Abraham Wu, Karyn A Goodman","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This study was conducted to identify the factors associated with acute gastrointestinal (GI) toxicity during pelvic chemoradiotherapy (PCRT) in patients with rectal cancer.</p><p><strong>Methods: </strong>We analyzed 177 patients with rectal cancer treated from 2007 through 2010. Clinical information, including weekly diarrhea and proctitis toxicity grade during PCRT, was recorded. GI structures including bowel and anal canal were contoured. The associations between toxicity and clinical and dosimetric predictors were tested.</p><p><strong>Results: </strong>The median age was 60; 76 patients were women; 98 were treated with intensity-modulated radiotherapy (IMRT) and 79 with 3D conformal RT (3DCRT). A higher rate of grade 2+ diarrhea was observed in the women, starting at week 4 (24% women vs. 11% men, P = .01; week 5: 33% vs. 12%, P = .002), as well as in all the patients treated with 3DCRT (22% vs. 12% IMRT, P = .03; week 5: 32% vs. 11%, P = .001). On multivariate analysis, the normal tissue complication probability (NTCP) model including bowel V45 (bowel volume receiving ≥45 Gy) showed that being female, and use of 3DCRT, was most predictive of grade 2+ diarrhea (area under the curve [AUC] = 0.76; R S = 0.35; P < .001). A higher rate of grade 2+ proctitis was seen in patients <60 years of age starting at week 3 (21% vs. 9%, P = .02; week 4: 35% vs. 16%, P = .003). The NTCP model including anal canal V15 and younger age was most predictive of grade 2+ proctitis (AUC = 0.67; R S = 0.25; P < .001).</p><p><strong>Conclusions: </strong>Women and all patients who were treated with 3DCRT had higher rates of grade 2+ diarrhea, and the younger patients had a higher rate of grade 2+ proctitis during PCRT. The use of more stringent dosimetric constraints in higher risk patients is a strategy for minimizing toxicity.</p>","PeriodicalId":12695,"journal":{"name":"Gastrointestinal cancer research : GCR","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3849899/pdf/gcr129.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31932674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}