The impact of radiotherapy protocol on quality of life in patients with operable rectal cancer

This article evaluated the long-term quality of life of patients with rectal cancer, treated with either a short course of radiation before surgery, or postoperative chemo-radiation. Patients treated with pre-operative radiation reported worse sexual- and bowel-related functional outcomes.  

In patients with operable rectal cancer, surgery is often followed by radiotherapy, intended to destroy any residual cancer cells left after surgery. If left untreated, these cells could develop into a further cancer also known as a local recurrence. Local recurrence is a major problem resulting in poor quality of life (due to pain, bowel incontinence, rectal bleeding and infections), and is hard to cure. Radiotherapy therefore aims to reduce the risk of local recurrence. This study compared the impact of two radiotherapy protocols on patients’ quality of life up to 2 years after surgery.

The study included 563 patients with rectal cancer, who answered questionnaires before treatment and 2 years after surgery (known as a 'survey'). Patients were asked to score many aspects related to quality of life such as sexual function, general health and defecation problems.

281 of the participants received a short-course of radiotherapy before surgery. The other 282 patients were given the standard treatment: first surgery, during which a tissue specimen is examined by a pathologist; if the tumor was not removed completely (as determined by the pathologist) then a course of radiation combined with chemotherapy (chemo-radiation) is given. Chemo-radiation was given to 25 out of 282 patients (8.8%) in this group.

The survey demonstrated that sexual dysfunction in men was increased after surgery in both treatment groups. Six months after surgery patients who had received pre-operative radiation had significantly worse sexual function. Sexual dysfunction lasted (at least) 2 years after treatment. The women completing this part of the questionnaire (sexual dysfunction) were too few to make any conclusions. However, both men and women who received pre-operative radiotherapy reported worse fecal incontinence problems two years later, compared to patients in the standard-treatment group.

This survey study showed that the main issue affecting the quality of life in patients treated for rectal cancer is sexual dysfunction in men. This problem is associated with surgery itself, but can be made worse by radiation treatment before surgery. Pre-operative radiotherapy was also related to sustained fecal incontinence problems.

In conclusion, the study supports the standard practice of post-operative chemo-radiation given selectively to patients in whom surgery failed to remove the tumor completely.  

The reader of this study should be aware of its limitations:

First, only 25 patients (less than 10%) in the standard treatment group had chemo-radiation; this is not comparable to the 281 participants who had pre-operative radiation.

Second, a survey study gives subjective, sometimes biased information.

Third, the article does not specify the exact radiation and chemotherapy regimens given, nor do they mention the rates of local recurrence in each treatment group.