dc.contributor.advisor | Liersch, Torsten Prof. Dr. | |
dc.contributor.author | Michels, Beate | |
dc.date.accessioned | 2021-02-10T10:22:24Z | |
dc.date.available | 2021-02-18T23:50:02Z | |
dc.date.issued | 2021-02-10 | |
dc.identifier.uri | http://hdl.handle.net/21.11130/00-1735-0000-0005-1568-F | |
dc.identifier.uri | http://dx.doi.org/10.53846/goediss-8414 | |
dc.identifier.uri | http://dx.doi.org/10.53846/goediss-8414 | |
dc.language.iso | deu | de |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
dc.subject.ddc | 610 | de |
dc.title | Oxaliplatin in der perioperativen, multimodalen Behandlung (präoperative Chemoradiotherapie, TME-Chirurgie und postoperative Chemotherapie) des Rektumkarzinoms – eine monozentrische Analyse – | de |
dc.type | doctoralThesis | de |
dc.title.translated | Oxaliplatin in the perioperative, multimodal treatment (preoperative chemoradiotherapy, TME surgery and postoperative chemotherapy) of rectal cancer - a monocentric analysis - | de |
dc.contributor.referee | Braulke, Friederike PD Dr. | |
dc.date.examination | 2021-02-11 | |
dc.description.abstracteng | Due to conflicting study results, the use of oxaliplatin (OX) in perioperative multimodal treatment (MMT) for locally advanced adenocarcinoma of the rectum (LARC; clinically staged as cUICC stages II or III) is not recommended in national S3 guidelines "ColoRectal Carcinoma" (2019). Preoperative chemoradiotherapy (CRT: RT with 50.4 Gray combined with 5-fluorouracil (5-FU)), total mesorectal excision (TME) and adjuvant chemotherapy (CTx) with 5-FU continues to be considered as standard.
Between 07/2006 to 06/2016, a total of 177 LARC patients (55 w, 122 m; median age: 63 years) was treated at the university medical center of Göttingen (UMG) according to clinical trial protocols. Feasibility, toxicity (NCI-CTCAE criteria, version 4.03), and compliance to MMT (+/- OX) were investigated as well as treatment efficacy. Patients with cUICC stages II (4%), III (91%) and IV (5%), all localized < 12 cm above anal verge, were divided into cohort A (n=64, control: CRT + TME + adCTx (5-FU), B (n=63, intensified MMT: CRT+OX + TME + adCTx (FOLFOX) and C (n=50, total neoadjuvant treatment, TNT: CRT+OX + 3 applications of FOLFOX + TME).
In 98% RT and 95% CTx, the planned preoperative CRT could be administered (5% dose reduction). The amount of toxicity ≥ CTC-grade 3 was < 5%. For patients of cohorts A and B, postoperative adCTx was associated with low rates of toxicity (≥ CTC-grade 3: < 8%) and resulted in patient`s compliance of 77% (23% dose reduction). After surgery pathological control of specimen revealed optimal, moderate or poor quality of TME in 79%, 18% and 3% (according to MERCURY criteria), respectively. Sphincter-saving low anterior resections were performed in 71%. R0- and negative CRM-status (≥ 2 mm resection margin without cancer cells) as well as MMT-induced shrinkage in tumor extent (ypTE: ≤ 25 mm) were achieved in 96%, 92% and > 50%, respectively. Postsurgical staging revealed stages ypUICC-0 to -IV in 14.5%, 23.1%, 27.7%, 24.9% and 9.6%, respectively. During median follow-up of 73 months, distant metastases were diagnosed in 31.3% and local recurrences in 5.4% of patients. Univariate analyses showed differences in DFS for MMT-induced tumor regression (p = 0.001), ypCRM (p = 0.002) and ypTE (p = 0.023) status as well as in ypUICC stages (p < 0.0009). In multivariate CSS analysis (forest plot), ≤ ypUICC stages II had longer CSS (p = 0.007; HR: 0.31; 95% CI: 0.14-0.73).
The use of OX in perioperative MMT is safe, easy to apply and leads to strong early tumor regression, good compliance and promising survival, especially in TNT (cohort C). | de |
dc.contributor.coReferee | Meyer, Thomas Prof. Dr. | |
dc.subject.ger | Rektumkarzinom, Oxaliplatin, Multimodaltherapie, totale neoadjuvante Therapie, Überlebenszeiten (DFS und CSS) | de |
dc.subject.eng | Rectal cancer, oxaliplatin, multimodal therapy, total neoadjuvant therapy, survival times (DFS and CSS) | de |
dc.identifier.urn | urn:nbn:de:gbv:7-21.11130/00-1735-0000-0005-1568-F-8 | |
dc.affiliation.institute | Medizinische Fakultät | de |
dc.subject.gokfull | Chirurgie - Allgemein- und Gesamtdarstellungen (PPN619875968) | de |
dc.description.embargoed | 2021-02-18 | |
dc.identifier.ppn | 1748057588 | |
dc.creator.birthname | Skubich | de |