Evidence map›Paper›PMID 40276115›Full record

ArticleClinical and translational radiation oncology2025

ACO/ARO/AIO-22 - External beam radiotherapy combined with endorectal high-dose-rate brachytherapy in elderly and frail patients with rectal cancer: A prospective multicentre trial of the German Rectal Cancer Study Group.

Hendrik Dapper, Maximilian Fleischmann, Nikolaos Tselis, Markus Diefenhardt, Ralf-Dieter Hofheinz, Christian Weiß, Gerhard G Grabenbauer, Ricarda Merten, Anca-Ligia Grosu, Simon Kirste and 27 more

Abstract read
In one paragraph

Article in Clinical and translational radiation oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

37 authors.

Hendrik DapperDepartment of Radiation Oncology, Cyberknife and Radiation Therapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
Maximilian FleischmannDepartment of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany.
Nikolaos TselisDepartment of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany.
Markus DiefenhardtDepartment of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany.
Ralf-Dieter HofheinzMannheim Cancer Center, University Hospital Mannheim, Mannheim, Germany.
Christian WeißDepartment of Radiotherapy and Oncology, Community Hospital, Darmstadt, Germany.
Gerhard G GrabenbauerDepartment of Radiation Oncology and Radiotherapy, DiaCura & Klinikum Coburg, Coburg, Germany.
Ricarda MertenDepartment of Radiation Therapy, University of Erlangen-Nürnberg, Erlangen, Germany.
Anca-Ligia GrosuDepartment of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Simon KirsteDepartment of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Stefan RiekenDepartment of Radiation Oncology, Comprehensive Cancer Center Lower Saxony (CCC-N), University Hospital Göttingen (UMG), Göttingen, Germany.
Johannes ClaßenDepartment of Radiation Oncology, St. Vincentius-Kliniken gAG, Karlsruhe, Germany.
Christian LangerKempten Clinic, Kempten, Germany.
Thomas KuhntDepartment of Radiation Therapy, University of Leipzig, Leipzig, Germany.
Heinz SchmidbergerDepartment of Radiation Oncology and Radiation Therapy, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
Michael GhadimiDepartment of General, Visceral and Pediatric Surgery, University Medical Center, Göttingen, Germany.
Frank GiordanoDepartment of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany.
Ursula NestleDepartment of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany.
Stefan A KoerberDepartment of Radiation Oncology, Barmherzige Brüder Hospital Regensburg, Regensburg, Germany.
Felix BockDepartment of Radiotherapy and Oncology, University of Rostock, Rostock, Germany.
Matthias GeigerDepartment of Radiotherapy and Oncology, Ostfildern Medius Kliniken, Ostfildern, Germany.
Bülent PolatDepartment of Radiation Oncology, University of Würzburg, Würzburg, Germany.
Christiane J BrunsDepartment of Visceral Surgery, University of Cologne, Cologne, Germany.
Georg DieplingerDepartment of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf, University Hospital of Cologne, Cologne, Germany.
Felix PoppDepartment of Visceral Surgery, University of Cologne, Cologne, Germany.
Thomas ZanderDepartment of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Düesseldorf, University Hospital of Cologne, Cologne, Germany.
Thomas BrunnerDepartment of Radiation Oncology, Medical University of Graz, Graz, Austria.
Silke TribiusAsklepios Tumorzentrum Hamburg, AK St. Georg, Hermann-Holthusen Institute for Radiotherapy, Hamburg, Germany.
Dirk ArnoldAsklepios Tumorzentrum Hamburg, AK Altona, Department of Oncology and Hematology, Hamburg, Germany.
Georg WurschiDepartment of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena, Germany.
Pompiliu PisoDepartment of General Surgery, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany.
Tim FriedeDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
Juliane Hörner-RieberDepartment of Radiation Oncology, University Hospital Düsseldorf, Germany.
Eleni GkikaDepartment of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
Claus RödelDepartment of Radiation Oncology, University Hospital Johann Wolfgang Goethe University, Frankfurt, Germany.
Emmanouil FokasDepartment of Radiation Oncology, Cyberknife and Radiation Therapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
German Rectal Cancer Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: Rectal cancer disproportionately affects the elderly population, with more than half of cases diagnosed in individuals aged 70 years or older. Frail patients in this group often face significant challenges tolerating the standard treatment of total mesorectal excision (TME), due to elevated risks of surgical complications and perioperative morbidity. Advances in radiotherapy techniques offer a viable alternative, providing effective tumor control while minimizing treatment-related toxicity. Recent clinical trials, including OPERA and MORPEUS, have demonstrated that dose-escalated radiotherapy, which integrates external beam (chemo)radiotherapy (EBRT) with high-dose-rate endorectal brachytherapy (HDR-BT) or contact X-ray brachytherapy (CXB), can achieve high clinical response rates and facilitate organ preservation in younger, healthier patient cohorts. Building on these findings, the ACO/ARO/AIO-22 study seeks to adapt these innovative approaches to meet the needs of elderly and frail patients with rectal cancer. Methods/Design: The ACO/ARO/AIO-22 trial is a prospective multicentre controlled trial. Elderly (age ≥70 years) and/or frail patients with non-metastatic rectal adenocarcinoma (cT1-3d N0/+ M0, mrCRM - / +) localized 0-16 cm from the ano-cutaneous line, unable to undergo radical surgery can be included. The initial treatment comprises an external beam radiation (EBRT) regime with 13 × 3 Gy (total: 39 Gy) over a period of two and a half weeks. Following initial restaging 6.5 weeks after completion of EBRT, endorectal HDR-BT will be delivered with 3 weekly fractions of 8 Gy to a total dose of 24 Gy (prescribed at the radial margin of the tumor; with a maximum prescription depth of 10 mm); alternatively, with CXB with 90 Gy in 3 weekly fractions. The primary objective is complete or near complete clinical response (cCR or ncCR) and the second primary endpoint is quality of life (QoL) measured with the EORTC QLQ-ELD14, both at 12 months after treatment start. Discussion: The ACO/ARO/AIO-22 prospective multicentre trial will evaluate organ preservation rates and QoL after combining EBRT with endorectal HDR-BT in elderly and/or frail patients with rectal cancer.

Identifiers

PMID40276115
PMCPMC12020863

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.