Introduction

Multimodality treatment for locally advanced rectal cancer (LARC) can include long-course radiotherapy (LCRT) or short course radiotherapy (SCRT). Nonoperative management is increasingly pursued for those achieving a complete clinical response. Data regarding long-term function and quality-of-life (QOL) are limited.

Methods

Patients with LARC treated with radiotherapy from 2016 to 2020 completed the Functional Assessment of Cancer Therapy- General (FACT-G7), the Low Anterior Resection Syndrome Score (LARS) and the Fecal Incontinence QOL Scale (FIQOL). Univariate and multivariable linear regression analyses identified associations between clinical variables including radiation fractionation and the use of surgery versus non-operative management.

Results

Of 204 patients surveyed, 124 (60.8%) responded. Median (interquartile range) time from radiation to survey completion was 30.1 (18.3-43) months. Seventy-nine (63.7%) respondents received LCRT, and 45 (36.3%) received SCRT; 101 (81.5%) respondents underwent surgery, and 23 (18.5%) pursued nonoperative management. There were no differences in LARS, FIQoL or FACT-G7 between patients receiving LCRT versus SCRT. On multivariable analysis, only nonoperative management was associated with lower LARS score signifying less bowel dysfunction. Nonoperative management and female sex were associated with a higher FIQoL score signifying less disruption and distress from fecal incontinence issues. Finally, lower BMI at the time of radiation, female sex, and higher FIQoL score were associated with higher FACT-G7 scores signifying better overall QOL.

Conclusions

These results suggest long-term patient-reported bowel function and QOL may be similar for individuals receiving SCRT and LCRT for the treatment of LARC, but nonoperative management may lead to improved bowel function and QOL.

中文翻译：

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直肠腺癌盆腔放疗后患者报告的肠道功能和肠道相关生活质量：放疗分割和手术切除的影响

介绍

局部晚期直肠癌 (LARC) 的多学科治疗可包括长程放疗 (LCRT) 或短程放疗 (SCRT)。对于那些获得完全临床反应的患者，越来越多地寻求非手术治疗。有关长期功能和生活质量 (QOL) 的数据有限。

方法

2016 年至 2020 年接受放射治疗的 LARC 患者完成了癌症治疗功能评估 - 一般 (FACT-G7)、低位前切除综合征评分 (LARS) 和大便失禁生活质量量表 (FIQOL)。单变量和多变量线性回归分析确定了临床变量之间的关联，包括放射分割以及手术与非手术治疗的使用。

结果

在接受调查的 204 名患者中，有 124 名 (60.8%) 做出了回应。从辐射到调查完成的中位时间（四分位距）为 30.1 (18.3-43) 个月。79 名（63.7%）受访者接受了 LCRT，45 名（36.3%）受访者接受了 SCRT；101 名（81.5%）受访者接受了手术，23 名（18.5%）接受了非手术治疗。接受 LCRT 与 SCRT 的患者之间的 LARS、FIQoL 或 FACT-G7 没有差异。在多变量分析中，只有非手术治疗与较低的 LARS 评分相关，表明肠道功能障碍较少。非手术治疗和女性与较高的 FIQoL 评分相关，这意味着大便失禁问题造成的干扰和痛苦较少。最后，放疗时较低的 BMI、女性性别和较高的 FIQoL 评分与较高的 FACT-G7 评分相关，表明整体生活质量较好。

结论

这些结果表明，接受 SCRT 和 LCRT 治疗 LARC 的患者长期报告的肠道功能和生活质量可能相似，但非手术治疗可能会改善肠道功能和生活质量。