Health-related quality of life 14years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: Report of a multicenter randomised trial

Wiltink, L.M.; Chen, Tina Y.T.; Nout, Remi A.; Kranenbarg, Elma Meershoek-Klein; Fiocco, Marta; Laurberg, Søren; Velde, Cornelis J.H. van de; Marijnen, Corrie A.M.

doi:10.1016/j.ejca.2014.06.020

Cited by 83 publications

(58 citation statements)

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“…Therefore no conclusions could be drawn about general sexual functioning of females, neither about the sexual functioning of males over 14 years. However, previous HRQL analyses at 0-2 years and at 14 years irradiated patients reported more sexual dysfunction than surgery only patients [12,13]. This finding is also supported by other studies [8,25].…”

Section: Discussionsupporting

confidence: 80%

“…However, all other patient characteristics were equally balanced between the treatment arms and also no differences were found between the three groups of responders. In addition, age profiles at 14 years did not differ between responders and nonresponders of the questionnaire [13].…”

Section: Study Population and Compliancementioning

confidence: 91%

“…The EORTC QLQ-C30 was completed for all items in 82.2% of the responders, the EORTC QLQ-CR29 without the sexual items for 76.6%, and the questionnaire on bowel and urinary function for 59.9%. Allowing up to two missing items these rates were 95.1%, 92.4% and 84.6%, respectively [13].…”

Section: Study Population and Compliancementioning

confidence: 99%

“…Different HRQL questionnaires were used (Table I). Details of the questionnaires are reported previously [6,12,13].…”

Section: Measurementsmentioning

confidence: 99%

“…0-2 years), 5 years and 14 years after treatment [6,12,13]. Different HRQL questionnaires were used (Table I).…”

Section: Measurementsmentioning

confidence: 99%

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A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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Background: Total mesorectal excision (TME) combined with preoperative short-term radiotherapy (PRT) reduces local recurrence rates in rectal cancer treatment. However, treatment with radiotherapy increased morbidity and did not result in a longer survival. The aim of this analysis is to provide a comprehensive longitudinal overview of the health-related quality of life (HRQL) and symptoms experienced by rectal cancer patients in the Dutch randomized TME trial from baseline until 14 years after treatment. Methods: Rectal cancer patients (n ¼1530) were randomly allocated to PRT (5 Â 5 Gy) followed by TME or to TME alone. At baseline, 3, 6, 12, 18, and 24 months, 5 years and 14 years after treatment HRQL was evaluated in surviving patients (n ¼606, at 14 years after treatment). Results: None of the general symptoms differed significantly between PRT + TME and TME. However, in both treatment arms the general symptoms were increased at the diagnosis of rectal cancer, after surgery and by aging. With PRT + TME bowel symptoms were increased, specifically more fecal incontinence was reported at all time points, resulting in more use of pads for fecal incontinence (PRT + TME vs. TME at 5 years 51.5% vs. 30.5%, respectively, and at 14 years 56.4% vs. 37.1%, respectively).Conclusions: This longitudinal analysis shows that general symptoms in both groups are increased at the diagnosis of rectal cancer, after surgery and by aging, but not by RT. However, irradiated patients reported more bowel dysfunction at all time points.

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Section: Discussionsupporting

confidence: 80%

Section: Study Population and Compliancementioning

confidence: 91%

Section: Study Population and Compliancementioning

confidence: 99%

“…Different HRQL questionnaires were used (Table I). Details of the questionnaires are reported previously [6,12,13].…”

Section: Measurementsmentioning

confidence: 99%

“…0-2 years), 5 years and 14 years after treatment [6,12,13]. Different HRQL questionnaires were used (Table I).…”

Section: Measurementsmentioning

confidence: 99%

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A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

et al. 2015

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Long-term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach

et al. 2023

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ImportanceA watch-and-wait approach for patients with rectal cancer and a clinical complete response after neoadjuvant chemoradiotherapy or radiotherapy is associated with better quality of life and functional outcome. Nevertheless, prospective data on both parameters are scarce.ObjectiveTo prospectively evaluate quality of life and functional outcome, including bowel, urinary, and sexual function, of patients following a watch-and-wait approach.Design, Setting, and ParticipantsA total of 278 patients with rectal cancer and a clinical complete response or near-complete response after neoadjuvant chemoradiotherapy or radiotherapy were included in 2 prospective cohort studies: a single-center study (March 2014 to October 2017) and an ongoing multicenter study (from September 2017). Patients were observed by a watch-and-wait approach. Additional local excision or total mesorectal excision was performed for residual disease or regrowth. Data were analyzed between April 1, 2021, and August 27, 2021, for patients with a minimum follow-up of 24 months.Main Outcomes and MeasuresQuality of life was evaluated with the European Organisation for Research and Treatment of Cancer–Quality of Life Questionnaire–C30 (EORTC-QLQ-C30), EORTC-QLQ-CR38, or EORTC-QLQ-CR29 and 36-Item Short-Form Health Survey. The score for the questionnaires and 36-Item Short-Form Health Survey ranges from 0 to 100. For some scales, a high score indicates a high level of functioning, and for others it indicates a high level of complaints and symptomatology. Functional outcome was assessed by the Low Anterior Resection Syndrome score, Vaizey incontinence score, International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index.ResultsOf 278 patients included, 187 were male (67%), and the median age was 66 years (range, 34-85 years). In the first 24 months, 221 patients (80%) were observed by a watch-and-wait approach without requiring surgery, 18 patients (6%) underwent additional local excision, and 39 patients (14%) underwent total mesorectal excision. In general, patients observed by a watch-and-wait approach reported good quality of life, with limited variation over time. At 3 months, 56 of 221 patients (25.3%) reported major bowel dysfunction; at 12 months, 53 patients (24.0%) reported it; and at 24 months, 55 patients (24.9%) reported it. At 24 months, 48 of 151 male patients (31.8%) reported severe erectile dysfunction. For female patients, sexual satisfaction and overall sexual function decreased during follow-up. Patients who underwent local excision reported more major bowel dysfunction (10 of 18 patients [55.6%]) compared with those without additional surgery. Quality-of-life scores, however, were comparable. After total mesorectal excision, patients scored significantly worse on several quality-of-life subscales.Conclusions and RelevanceResults of this study suggest that patients with rectal cancer who were observed by a watch-and-wait approach had good quality of life, with some patients reporting bowel and sexual dysfunction. Quality of life and functional outcome deteriorated when patients required surgery. These data will be useful in daily care to counsel patients on what to expect from a watch-and-wait approach.

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Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter retrospective cohort study in Japan

Kozu,

Akiyoshi,

Sakamoto

et al. 2024

Annals of Gastroent Surgery

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BackgroundIdentifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large‐scale studies to evaluate risk factors for LR are limited.MethodsData from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine–Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.ResultsAcross the entire cohort, the 5‐year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7–14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment‐related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m2, distance from anal verge ≤4.0 cm, non‐well/moderately differentiated adenocarcinoma). The 5‐year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.ConclusionThis large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.

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Health-related quality of life 14years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: Report of a multicenter randomised trial

Cited by 83 publications

References 28 publications

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial

Long-term Quality of Life and Functional Outcome of Patients With Rectal Cancer Following a Watch-and-Wait Approach

Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter retrospective cohort study in Japan

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