Acute toxicity after a diverting stoma and spacer prior to chemoradiation in locally advanced rectal cancer

• Published in: Radiotherapy and oncology 2015-07, Vol.116 (1), p.107-111
• Main Authors: van der Voort van Zyp, Jochem R.N, Ceha, Heleen M, Niehe, Valerie, Marinelli, Andreas W.K.S, Putter, Hein, Marijnen, Corrie A.M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Diverting stoma; Female; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Neoplasm Staging; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Retrospective Studies; Small bowel; Spacer; Surgical Stomas; Tomography, X-Ray Computed; Toxicity
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2015.06.001

Abstract Background and purpose 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. Materials/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 20 Gy. 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). Conclusion 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.