III. Medizinische Klinik, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer Ufer 1-3, 68167 Mannheim, Germany.
Eur J Surg Oncol. 2012 Jun;38(6):472-7. doi: 10.1016/j.ejso.2012.02.002. Epub 2012 Feb 18.
In spite of advances in rectal cancer surgery and the use of preoperative 5-fluorouracil-(5-FU) based chemoradiotherapy (CRT) in stage II and III disease distant metastases still occur in about 35-40% of the patients. Intensified preoperative CRT (ICRT) using other drugs in conjunction with 5-FU has been investigated in order to improve the pathological complete remission (pCR) rate and thereby prognosis of patients with locally advanced rectal cancer. However, acute toxicity, especially diarrhea, was reported to be high and no improvement in pCR rates has been observed in randomized trials. Long-term results of these trials are pending. In the present analysis we investigated the impact of ICRT on health related quality of life and long term toxicity.
The present study included 119 patients with locally advanced rectal cancer who underwent neoadjuvant CRT followed by surgery within controlled clinical trials. Patients received ICRT (n = 83) or standard CRT (n = 36). Evaluation of HRQoL was performed using EORTC QLQ-C30 and QLQ-CR29 questionnaires.
The overall rating of global health status/QLQ scale of the EORTC QLQ-C30 questionnaire was identical in both patient groups but patients in the CRT group showed better results in four out of nine function scales. Concerning symptom scales, patients in the CRT arm exhibited significantly less diarrhea (p = 0.028) and less disorders with taste (0.042).
This data suggests that higher gastrointestinal acute toxicity caused by ICRT might lead to a higher risk of long-term deterioration of "gastrointestinal QoL". Future results of randomized trials investigating ICRT versus CRT should be discussed in the light of long-term QoL data.
尽管直肠癌手术取得了进展，并且在 II 期和 III 期疾病中使用了术前氟尿嘧啶（5-FU）为基础的放化疗（CRT），但远处转移仍发生在约 35-40%的患者中。为了提高局部晚期直肠癌患者的病理完全缓解（pCR）率和预后，已经研究了使用其他药物联合 5-FU 的强化术前 CRT（ICRT）。然而，急性毒性，特别是腹泻，报道发生率较高，并且随机试验并未观察到 pCR 率的改善。这些试验的长期结果仍在等待中。在本分析中，我们研究了 ICRT 对健康相关生活质量和长期毒性的影响。
本研究包括 119 例局部晚期直肠癌患者，他们在对照临床试验中接受新辅助 CRT 后进行手术。患者接受 ICRT（n = 83）或标准 CRT（n = 36）。使用 EORTC QLQ-C30 和 QLQ-CR29 问卷评估 HRQoL。
EORTC QLQ-C30 问卷的全球健康状况/QLQ 量表的总体评分在两组患者中相同，但 CRT 组的患者在九个功能量表中的四个量表中表现出更好的结果。关于症状量表，CRT 组的患者腹泻明显较少（p = 0.028），味觉障碍也明显较少（0.042）。
这些数据表明，ICRT 引起的更高的胃肠道急性毒性可能导致长期胃肠道生活质量恶化的风险更高。未来应根据长期 QoL 数据讨论研究 ICRT 与 CRT 的随机试验结果。
