Abstract
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.
Keywords
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Article info
Publication history
Published online: February 15, 2023
Accepted:
February 10,
2023
Received:
August 8,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
