Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial
Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial
复制标题
长程新辅助放疗对直肠癌术后低位前切除综合征和生活质量的影响：随机对照试验的事后分析
DOI：
10.1245/s10434-018-07096-8
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发表时间：
2019-03-01
影响因子：
3.7
通讯作者：
Wang, Jianping
中科院分区：
文献类型：
--
作者：
Sun, Weipeng;Dou, Ruoxu;Wang, Jianping
背景新辅助放疗被推荐用于局部进展期直肠癌，已证实对局部控制有益处，但对无病生存率无益处。然而，长期放疗对术后肠功能和生活质量（QOL）的影响仍存在争议。本研究的目的是调查的影响，长期的新辅助放疗对肠功能和生活质量，并确定危险因素严重bowel dysfunction.MethodsPatients谁接受长期的新辅助放化疗（nCRT）或化疗（nCT），其次是根治性低前切除术局部进展期直肠癌从FOWARC随机对照试验招募。低位前切除术综合征（LARS）评分和欧洲癌症研究与治疗组织（EORTC）C30/CR29问卷分别用于评估肠功能和QOL，ResultsOverall，220例患者在中位随访40.2个月后有应答，其中119例患者中有110例患者在术后12个月内有应答。54.1%报告了严重LARS，74例（33.6%）报告了轻微LARS，27例（12.3%）未报告LARS。与nCT组相比，nCRT组报告的主要LARS更多（64.4%vs.38.6%，p < 0.001），生活质量更差。长疗程新辅助放疗（OR 2.20，95% CI 1.24-3.91;p= 0.007），吻合高度（OR 0.74，95% CI 0.63-0.88;p< 0.001），回肠造口术（OR 2.59，95% CI 1.27-5.30; p= 0.009）是主要LARS的独立危险因素。可能是术后肠功能和生活质量的独立危险因素。我们的研究结果可能对减轻LARS和改善生活质量的新辅助治疗的选择提供信息。
BackgroundNeoadjuvant radiation is recommended for locally advanced rectal cancer, with proven benefit in local control but not in disease-free survival. However, the impact of long-course radiation on postoperative bowel function and quality of life (QOL) remains controversial. This study aimed to investigate the impact of long-course neoadjuvant radiation on bowel function and QOL, and to identify risk factors for severe bowel dysfunction.MethodsPatients who underwent long-course neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT) followed by radical low anterior resection for locally advanced rectal cancer were recruited from the FOWARC randomized controlled trial. Low anterior resection syndrome (LARS) score and European Organisation for Research and Treatment of Cancer (EORTC) C30/CR29 questionnaires were used to assess bowel function and QOL, respectively.ResultsOverall, 220 patients responded after a median follow-up of 40.2 months, of whom 119 (54.1%) reported major LARS, 74 (33.6%) reported minor LARS, and 27 (12.3%) reported no LARS. Compared with the nCT group, the nCRT group reported more major LARS (64.4% vs. 38.6%,p< 0.001) and worse QOL. Long-course neoadjuvant radiation (OR 2.20, 95% CI 1.24–3.91;p= 0.007), height of anastomosis (OR 0.74, 95% CI 0.63–0.88;p< 0.001), and diverting ileostomy (OR 2.59, 95% CI 1.27–5.30;p= 0.009) were independent risk factors for major LARS.ConclusionsLong-course neoadjuvant radiation, along with low anastomosis, are likely independent risk factors for postoperative bowel function and QOL. Our findings might have implications for alleviating LARS and improving QOL by informing selection of neoadjuvant treatment.