Pietrzak Lucyna, Bujko Krzysztof, Nowacki Marek P, Kepka Lucyna, Oledzki Janusz, Rutkowski Andrzej, Szmeja Jacek, Kladny Jozef, Dymecki Dariusz, Wieczorek Andrzej, Pawlak Mariusz, Lesniak Tadeusz, Kowalska Teresa, Richter Piotr
Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
Radiother Oncol. 2007 Sep;84(3):217-25. doi: 10.1016/j.radonc.2007.07.007. Epub 2007 Aug 10.
Patients (N=316) with resectable cT3-4 low-lying and mid-rectal cancer were randomised to receive either preoperative 5x5Gy irradiation with subsequent surgery performed within 7 days or chemoradiation (50.4, 1.8Gy per fraction plus boluses of 5-fluorouracil and leucovorin) followed by surgery after 4-6 weeks. No differences were found in sphincter preservation, survival, local control and late complications. Early complications were less frequent in the short-course group. The aim of this report is to find out whether large doses per fraction of short-course schedule result in more severe anorectal and sexual dysfunction and quality of life (QoL) impairment.
Patients who were free of disease were asked to answer the QLQ-C30 and those without stoma were, additionally, asked to fill in a questionnaire of anorectal (19 items) and sexual function (1 item).
Two hundred and twenty-two patients (86% response rate) completed the QLQ-C30 and 118 (86% response rate) the anorectal-sexual function questionnaire. The median time from surgery to filling in the QLQ-C30 questionnaire was 12 months, and to filling in the anorectal-sexual function questionnaire - 13 months. We did not find significant differences between the randomised groups regarding QoL and the anorectal and sexual functions. Approximately two-thirds of patients had anorectal function impairment. Approximately 20% of patients stated that this considerably influenced their QoL.
QoL and the anorectal and sexual functioning did not differ in patients receiving short-course radiotherapy, as compared to those receiving chemoradiation.
316例可切除的cT3 - 4期低位和中位直肠癌患者被随机分组，一组接受术前5×5Gy照射，随后在7天内进行手术；另一组接受放化疗（50.4Gy，每次分割剂量1.8Gy，加用5-氟尿嘧啶和亚叶酸钙推注），4 - 6周后进行手术。在括约肌保留、生存率、局部控制和晚期并发症方面未发现差异。短程放疗组的早期并发症较少。本报告的目的是探讨短程放疗方案中每分次大剂量是否会导致更严重的肛肠和性功能障碍以及生活质量（QoL）受损。
无疾病的患者被要求回答QLQ - C30问卷，无造口的患者还需填写一份肛肠功能（19项）和性功能（1项）问卷。
222例患者（应答率86%）完成了QLQ - C30问卷，118例患者（应答率86%）完成了肛肠 - 性功能问卷。从手术到填写QLQ - C30问卷的中位时间为12个月，到填写肛肠 - 性功能问卷的中位时间为13个月。在生活质量以及肛肠和性功能方面，随机分组的两组之间未发现显著差异。约三分之二的患者存在肛肠功能障碍。约20%的患者表示这对他们的生活质量有很大影响。
与接受放化疗的患者相比，接受短程放疗的患者在生活质量以及肛肠和性功能方面没有差异。
