Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: Increased bowel dysfunction in irradiated patients - A dutch colorectal cancer group study
Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: Increased bowel dysfunction in irradiated patients - A dutch colorectal cancer group study
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DOI：
10.1200/jco.2005.14.779
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发表时间：
2005-09-01
影响因子：
45.3
通讯作者：
Marijnen, CAM
中科院分区：
文献类型：
--
作者：
Peeters, KCMJ;van de Velde, CJH;Marijnen, CAM
目的术前短期放疗可提高全直肠系膜切除术(TME)患者的局部控制率。本研究旨在评估术前5x5Gy放疗和TME的远期副作用的存在和严重程度。同时，对可能与直肠癌治疗的晚期副作用有关的疾病进行住院治疗。患者和方法从前瞻性随机试验中评估患者的长期发病率，该试验调查了5x5Gy术前对移动性直肠癌的疗效。结果共获得597例患者的结果，中位随访时间为5.1年。造口功能、排尿功能和医院治疗率在治疗组之间没有显著差异。然而，与未接受照射的患者相比，接受照射的患者报告了更多的大便失禁(分别为62%和38%；P<；.001)、因尿失禁导致的垫磨损(分别为56%和33%；P<；.001)、肛门出血(分别为11%和3%；P=.004)和粘液丢失(分别为27%和15%；P<；.005)。放疗患者的肠道功能满意度明显低于单纯放疗患者，肠功能障碍对日常生活活动的影响大于单纯放疗患者。结论虽然直肠癌患者术前短期放疗可提高局部控制率，但放疗患者较单纯放疗患者存在更多的远期肠道功能障碍。应告知直肠癌患者放疗和TME的晚期发病率。未来的策略应该着眼于选择局部失败风险较高的患者进行放射治疗。
Purpose Preoperative short-term radiotherapy improves local control in patients treated with total mesorectal excision (TME). This study was performed to assess the presence and magnitude of long-term side effects of preoperative 5 x 5 Gy radiotherapy and TME. Also, hospital treatment was recorded for diseases possibly related to late side effects of rectal cancer treatment.Patients and Methods Long-term morbidity was assessed in patients from the prospective randomized THE trial, which investigated the efficacy of 5 x 5 Gy before THE surgery for mobile rectal cancer. Dutch patients without recurrent disease were sent a questionnaire.Results Results were obtained from 597 patients, with a median follow-up of 5.1 years. Stoma function, urinary function, and hospital treatment rates did not differ significantly between the treatment arms. However, irradiated patients, compared with nonirradiated patients, reported increased rates of fecal incontinence (62% v 38%, respectively; P < .001), pad wearing as a result of incontinence (56% v 33%, respectively; P < .001), anal blood loss (11 % v 3%, respectively; P = .004), and mucus loss (27% v 15%, respectively; P < .005). Satisfaction with bowel function was significantly lower and the impact of bowel dysfunction on daily activities was greater in irradiated patients compared with patients who underwent THE alone.Conclusion Although preoperative short-term radiotherapy for rectal cancer results in increased local control, there is more long-term bowel dysfunction in irradiated patients than in patients who undergo THE alone. Rectal cancer patients should be informed on late morbidity of both radiotherapy and TME. Future strategies should be aimed at selecting patients for radiotherapy who are at high risk for local failure.