NTCP models predicting bowel toxicity after total neoadjuvant treatment or chemoradiation for rectal cancer in the RAPIDO trial.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42556586.
- Also identified by DOI 10.1016/j.ijrobp.2026.07.044.
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Abstract
Radiation-induced bowel toxicity is a frequently observed adverse event after rectal cancer treatment. In the phase III RAPIDO trial, patients with locally advanced rectal cancer received either short-course radiation therapy (SCRT, 5×5 Gy) with consolidation chemotherapy (TNT arm) or chemoradiation with optional postoperative chemotherapy (CRT arm). We developed normal tissue complication probability (NTCP) models for bowel toxicity after SCRT-based TNT and CRT, using two different bowel contour definitions. NTCP models were developed for each arm separately using EMBRACE and RTOG bowel contours. Evaluated dose-parameters were the V<sub>10Gy</sub>, V<sub>15Gy</sub>, and V<sub>20Gy</sub> in the TNT and V<sub>15Gy</sub>, V<sub>30Gy</sub>, and V<sub>40Gy</sub> in the CRT arm. Endpoints included acute diarrhea grade ≥ 2, non-compliance with preoperative chemotherapy, late diarrhea grade ≥ 1, and patient-reported late diarrhea. Associations were assessed with uni- and multivariable logistic regression models, and model performance with the area-under-the-curve (AUC) and calibration plots. The numbers of eligible patients in the TNT arm were 309 (acute toxicity), 221 (late diarrhea grade ≥ 1) and 209 (patient-reported late diarrhea), whereas in the CRT arm respective numbers were 279, 191 and 190. Acute diarrhea grade ≥ 2 was reported in 38% (TNT) and 28% (CRT) of the patients. All dose-parameters (from both bowel contours) showed comparable associations with the endpoint acute diarrhea grade ≥ 2. In the TNT arm, p-values ranged from .003 to .08 and cross-validated AUCs from 0.48 to 0.61. In the CRT arm p-values ranged from <.001 to .03 and cross-validated AUCs from 0.56 to 0.67. All models were reasonably well calibrated. In addition, associations were observed between dose-parameters and late diarrhea grade ≥ 1 in the CRT arm. The evaluated dose-parameters were able to predict acute diarrhea after SCRT-based TNT and CRT, and late diarrhea after CRT. Model performance was better in the CRT arm than the TNT arm. Both the EMBRACE bowelloop and RTOG bowelbag contour can be used to guide treatment plan optimization.