Radiotherapy Before Total Mesorectal Excision Has Small Impact On Long-Term Life Quality

Preoperative radiotherapy before total mesorectal excision for rectal cancer has little effect on overall quality of life 14 years later, despite persistent treatment-related symptoms

medwireNews: Very long-term health-related quality of life (HRQoL) in patients who receive short-term radiotherapy before total mesorectal excision (TME) for rectal cancer is similar to that of the general population, shows follow-up of the Dutch TME trial.

This was despite patients who underwent preoperative radiotherapy reporting more bowel problems and sexual dysfunction than those assigned to TME alone, at a median of 14 years after the procedure.

One reason for this may be that patients adapt to their symptoms, say researcher Corrie Marijnen, from Leiden University Medical Center, the Netherlands, and colleagues, “especially 14 years after treatment”.

At follow-up, 606 of the original 1530 trial participants remained alive, of whom 478 completed a questionnaire combining relevant elements of several European Organization for Research and Treatment of Cancer questionnaires.

The 241 patients who underwent radiotherapy reported worse bowel function than the 237 who did not, although this difference was confined to the approximately 60% of patients who did not have a stoma. Among these patients, those in the radiotherapy group more commonly reported a slight increase in stool frequency than those in the TME only group (41.4 vs 28.6%). They were also more likely to have faecal leakage (54.3 vs 72.6% with no leakage after surgery), and had more urge for defecation, more anal mucus leakage and required more use of incontinence pads.

But despite this, although patients’ scores for HRQoL items including fatigue, appetite loss, constipation and diarrhoea were poorer than that of the general Dutch population, the differences were “small in terms of clinical relevance”, and their overall average scores were equivalent.

Among the 40.9% of men who were sexually active, those in the radiotherapy group had more erectile difficulties than those in the TME only group, with 50.5% versus 29.8% reporting “very much difficulty”. And for both groups there was a large difference relative to men in the general population. Trial participants also reported less sexual interest than men in the general population, with these differences being of moderate clinical relevance.

For the 29.9% of women who were sexually active, sexual problems predominantly affected those who had received radiotherapy, with these women reporting clinically large differences in enjoyment of sex and pain during intercourse, compared with women in the general population, as well as moderate differences in vaginal dryness.

Corrie Marijnen and team note that newer radiation techniques can minimise damage to healthy tissue, thereby reducing acute bowel toxicity.

“Although likely, it is not yet clear if these new radiation techniques also decrease long-term treatment-related toxicity”, they write in the European Journal of Cancer. “Therefore, optimal patient selection for radiotherapy is required, ensuring that only patients who are most likely to benefit from radiotherapy should receive this treatment.”

Reference

Wiltink LM, Chen TYT, Nout RA,et al.Health-related quality of life 14 years after preoperative short-term radiotherapy and total mesorectal excision for rectal cancer: Report of a multicenter randomised trial. Eur J Cancer 2014 July 21. doi: 10.1016/j.ejca.2014.06.020

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