Hupkens Britt J P, Martens Milou H, Stoot Jan H, Berbee Maaike, Melenhorst Jarno, Beets-Tan Regina G, Beets Geerard L, Breukink Stéphanie O
1 Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; 2 Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands; 3 GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands 4 Department of Surgery, Zuyderland, Heerlen/Sittard, the Netherlands 5 Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands 6 Department of Radiology, Netherlands Cancer Institute, the Netherlands; 7 Department of Surgery, Netherlands Cancer Institute, the Netherlands.
Dis Colon Rectum. 2017 Oct;60(10):1032-1040. doi: 10.1097/DCR.0000000000000862.
Fifteen to twenty percent of patients with locally advanced rectal cancer have a clinical complete response after chemoradiation therapy. These patients can be offered nonoperative organ-preserving treatment, the so-called watch-and-wait policy. The main goal of this watch-and-wait policy is an anticipated improved quality of life and functional outcome in comparison with a total mesorectal excision, while maintaining a good oncological outcome.
The aim of this study was to compare the quality of life of watch-and-wait patients with a matched-controlled group of patients who underwent chemoradiation and surgery (total mesorectal excision group).
This was a matched controlled study.
This study was conducted at multiple centers.
The study population consisted of 2 groups: 41 patients after a watch-and-wait policy and 41 matched patients after chemoradiation and surgery. Patients were matched on sex, age, tumor stage, and tumor height. All patients were disease free at the moment of recruitment after a minimal follow-up of 2 years.
Quality of life was measured by validated questionnaires covering general quality of life (Short Form 36, European Organization for Research and Treatment of Cancer QLQ-C30), disease-specific total mesorectal excision (European Organization for Research and Treatment of Cancer QLQ-CR38), defecation problems (Vaizey and low anterior resection syndrome scores), sexual problems (International Index of Erectile Function and Female Sexual Function Index), and urinary dysfunction (International Prostate Symptom Score).
The watch-and-wait group showed better physical and cognitive function, better physical and emotional roles, and better global health status compared with the total mesorectal excision group. The watch-and-wait patients showed fewer problems with defecation and sexual and urinary tract function.
This study only focused on watch-and-wait patients who achieved a sustained complete response for 2 years. In addition, this is a study with a limited number of patients and with quality-of-life measurements on nonpredefined and variable intervals after surgery.
After a successful watch-and-wait approach, the quality of life was better than after chemoradiation and surgery on several domains. However, chemoradiation therapy on its own is not without long-term side effects, because one-third of the watch-and-wait patients experienced major low anterior resection syndrome symptoms, compared with 66.7% of the patients in the total mesorectal excision group. See Video Abstract at http://links.lww.com/DCR/A395.
15%至20%的局部晚期直肠癌患者在接受放化疗后会出现临床完全缓解。这些患者可接受非手术保器官治疗，即所谓的观察等待策略。与全直肠系膜切除术相比，这种观察等待策略的主要目标是预期提高生活质量和功能结局，同时保持良好的肿瘤学结局。
本研究旨在比较观察等待患者与接受放化疗及手术的匹配对照组（全直肠系膜切除术组）患者的生活质量。
这是一项匹配对照研究。
本研究在多个中心进行。
研究人群包括两组：41例采用观察等待策略的患者和41例接受放化疗及手术的匹配患者。患者在性别、年龄、肿瘤分期和肿瘤高度方面进行了匹配。所有患者在入组时经过至少2年的随访均无疾病。
通过经过验证的问卷来测量生活质量，这些问卷涵盖一般生活质量（简明健康状况调查量表、欧洲癌症研究与治疗组织QLQ-C30）、疾病特异性全直肠系膜切除术（欧洲癌症研究与治疗组织QLQ-CR38）、排便问题（韦齐评分和低位前切除综合征评分）、性功能问题（国际勃起功能指数和女性性功能指数）以及排尿功能障碍（国际前列腺症状评分）。
与全直肠系膜切除术组相比，观察等待组显示出更好的身体和认知功能、更好的身体和情感角色以及更好的整体健康状况。观察等待患者在排便、性功能和泌尿道功能方面的问题较少。
本研究仅关注那些实现持续完全缓解2年的观察等待患者。此外，这是一项患者数量有限的研究，且生活质量测量是在术后未预先定义的可变时间间隔进行的。
在成功实施观察等待策略后，在几个方面的生活质量优于放化疗及手术后。然而，单纯的放化疗并非没有长期副作用，因为三分之一的观察等待患者出现了严重的低位前切除综合征症状，而全直肠系膜切除术组的这一比例为66.7%。见视频摘要：http://links.lww.com/DCR/A395 。
