S700
Clinical – Lower GI
ESTRO 2026
5 Department of Radiotherapy and Radiation Oncology, Rostock University Medical Center, Rostock, Germany. 6 Department of Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria. 7 Department of Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. 8 German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité, Universitätsmedizin Berlin, Berlin, Germany. 9 Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany. 10 Frankfurt Cancer Institute (FCI), Goethe University Frankfurt, Frankfurt, Germany. 11 Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany. 12 Department of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 13 Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany. 14 Partner Site Tübingen, German Cancer Consortium (DKTK), Tübingen, Germany. 15 Department of Radiation Oncology, University Medical Center Leipzig, Leipzig, Germany. 16 Department of Radiation Oncology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK), partner site DKTK-Freiburg, Freiburg, Germany. 17 Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Essen, Germany. 18 Department of Radiooncology, Klinikum Stuttgart, Stuttgart, Germany. 19 Department of Radiotherapy, University Medical Center Schleswig-Holstein/Lübeck, Lübeck, Germany. 20 Department of Radiooncology, University Medical Center of the Johannes-Gutenberg-University Mainz, Mainz, Germany. 21 Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander- Universität Erlangen-Nürnberg, Erlangen, Germany. 22 Department of Radiation Oncology, Otto von Guericke Universität Magdeburg, Magedburg, Germany. 23 Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine and Klinikum Rechts der Isar, Munich, Germany. 24 Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 25 Center for Radiotherapy and Radiation Oncology, Radiotherapy North, Bremen, Germany. 26 Department for Radiotherapy, University Hospital Halle, Halle (Saale), Germany. 27 Center of Integrated Oncology Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany. 28 Department of Radiation Oncology, University Hospital Schleswig- Holstein Campus Kiel, Kiel, Germany. 29 Center for Clinical Studies, Jena University Hospital, Jena, Germany. 30 Department of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena,
Germany. 31 Campus Jena, Comprehensive Cancer Center Central Germany (CCCG), Jena, Germany
Purpose/Objective: Whether sex modifies the efficacy and toxicity of total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) remains unclear. We conducted a predefined sex-specific subanalysis in a large
multicentre cohort. Material/Methods: Patients receiving TNT with consolidation
chemotherapy for LARC (UICC Stage II/III) between 2015 and 2024 across 23 centres were included. The primary endpoint was complete response (CR) at the first post-treatment assessment (clinical or pathological). Secondary endpoints comprised toxicity during TNT and at follow-up (CTCAE v5.0), postoperative complications (Clavien-Dindo), tumour control, and survival. Between-sex comparisons were performed and summarised descriptively using absolute and relative frequencies (n, %) or median values with first and third quartiles (Q1–Q3), depending on the type of variable. Failure-free survival (FFS) and overall survival (OS) were stratified by sex and reported using the Kaplan–Meier method, with differences between sexes evaluated by log-rank tests. Results: 295 patients were retrospectively analysed (85 women/210 men). CR rates were comparable: 50.6% in women (43/85) versus 48.6% in men (102/210). Management of CR was similar, as comparable rates for clinical CR (51 men, 24.3%; 21 women, 24.7%) and pathological CR (51 men, 24.3%; 19 women, 22.4%) were reported. Conversely, acute high-grade toxicity differed. Any grade ≥ 3 toxicity occurred in 42.2% of women (35/83 evaluable) versus 24.9% of men (51/205). Site-specific grade ≥ 3 events during TNT were higher in women for diarrhoea (13.6% vs 3.6%), fatigue (9.0% vs 3.6%), leukopenia (18.2% vs 7.3%), and
neutropenia (17.1% vs 4.5%) (Figure 1). Polyneuropathy grade ≥ 3 during TNT and postoperative complications grade ≥ 3 were
numerically higher in men (6.5% vs 4.9% and 24.8% vs 14.1%, respectively), whereas grade ≥ 2 toxicity was slightly higher in women (50.0% vs 45.1%). During follow-up (median 20 months (Q1-Q3: 15-25)), no statistically significant differences for FFS (p=0.951) and OS were observed (p=0.720). The 18-months FFS rates (men: 84.1%, 95%-CI: 78.7%-90.0%; women: 82.4%, 95%-CI: 73.5%-92.5%) and OS rates (men: 95.4%, 95%-CI: 92.0%-98.8%, women: 98.6%, 95%-CI: 95.8%-100.0%) were similar.Figure 1. Selected grade ≥ 3 toxicities by sex.
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