The Long-Term Effect of Adjuvant Postoperative Chemoradiotherapy for Rectal Carcinoma on Bowel Function

Abstract

ObjectiveThe authors assessed the long-term effect of postoperative chemoradiotherapy on bowel function. Summary Background DataAdjuvant postoperative radiation therapy, often combined with chemotherapy, is being used increasingly often for rectal carcinoma. However, the long-term effect of this treatment on bowel function has not been investigated. MethodsThe records were reviewed of all patients undergoing anterior resection for rectal carcinoma 2 to 5 years previously. During this period, patients with Astler-Coller stage B2 or C tumors generally were given postoperative radiation therapy with chemotherapy, whereas those with earlier stage tumors were not. To minimize possible confounding factors that may have been more common in the group receiving chemoradiotherapy and that may affect bowel function, extensive exclusion criteria were used, such as invasion of contiguous organs, local or distant metastases, use of a dysfunctioning stoma, and anastomotic or pelvic complications. One hundred remaining patients were suitable for inclusion in the study and participated in a telephone questionnaire; 41 patients had postoperative chemoradiotherapy, and 59 did not. ResultsThe two groups were well matched for sex, level of anastomosis, and length of follow-up, although the group receiving chemoradiotherapy was slightly younger. The group that had chemoradiotherapy had more bowel movements per day than the group that did not have radiation therapy (median 7 vs. median 2, p < 0.001); the former group had "clustering" of bowel movements more often (42% vs. 3%, p < 0.001), had nighttime movements more often (46% vs. 14%, p < 0.001), had occasional or frequent incontinence more often (39% and 17% vs. 7% and 0%, p < 0.001), wore a pad more often (41% vs. 10%, p < 0.001), and were unable to defer defecation for more than 15 minutes more often (78% vs. 19%, p < 0.001). The group that had chemoradiotherapy also had stool of liquid consistency, used antidiarrheal medications, had perianal skin irritation, were unable to differentiate stool from gas, and needed to defecate again within 30 minutes of a movement significantly more often than the group that did not receive chemoradiotherapy. 676

A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy

“…However, the frequency with which pelvic radiotherapy leads to side effects affecting QOL is not known. The literature suggests that it ranges from 6 to 78% of patients (Kollmorgen et al, 1994;Potosky et al, 2000;Gami et al, 2003;Kozelsky et al, 2003). This variation may reflect a true difference in chronic toxicity in different diseases using different techniques.…”

Role of nutritional intervention in patients treated with radiotherapy for pelvic malignancy

“…These include bowel obstruction, fistulation, intractable bleeding or secondary cancers. A further 6 -78% of patients develop less severe symptoms, which nevertheless detrimentally affect quality of life (Kollmorgen et al, 1994;Potosky et al, 2000;Gami et al, 2003). These may include urgency, frequency, faecal incontinence, diarrhoea, steatorrhoea, tenesmus, pain, constipation and weight loss .…”

Adjuvant postoperative radiotherapy in rectal cancer: 148 cases treated at Florence University with 8 years median follow-up

“…Letschert [36] in a retrospective review of 111 cases treated with radiation after rectal surgery, found a dose volume correlation for small bowel complications; the incidence of severe small bowel complications was 37% when 2 AP/PA large fields were used and 6% for limited threefield technique. The bowel function was assessed in detail by Kollmorgen et al [33] in a group of 100 cases with a minimum of 2 years follow-up after anterior resection of the rectum; 41 received postoperative chemoradiation, while 59 were only operated; night time bowel movements were present in 46% in the first group vs. 19% in the second, occasional incontinence in 39% vs. 17%, fecal urgency in 78% vs 19%. The LR rates reported after postoperative radiotherapy in the studies reviewed are between 6% and 25%.…”