The Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands.
Maastricht University Medical Center+, Department of Surgery, the Netherlands; Maastricht University Medical Center+, Department of Radiology, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands.
Radiother Oncol. 2019 Mar;132:79-84. doi: 10.1016/j.radonc.2018.11.017. Epub 2018 Dec 21.
To assess the long-term anorectal function in rectal cancer patients following a watch-and-wait policy after chemoradiotherapy and to investigate the dose-volume effects of radiotherapy on the anorectal function.
Thirty-three patients with primary rectal cancer who were treated with chemoradiotherapy and a watch-and-wait policy with minimum follow-up of 2 years were included. We assessed the anorectal function using anorectal manometry and patient reported outcomes (Vaizey and LARS score). Dose-volume histograms were calculated for the rectum and anal sphincter complex, and associations between the dose-volume parameters and anorectal function were assessed.
D to the rectum and anal sphincter complex was 50.5 Gy and 44.7 Gy, respectively. After a median follow-up of 38 (range 23-116) months, 33.3% of the patients reported major LARS. Mean LARS score was 23.4 ± 11.3 and mean Vaizey score was 4.3 ± 4.1. The most frequent complaints were clustering of defaecation and faecal urgency. Trends towards a higher Vaizey and LARS score after higher anal sphincter complex dose were observed, although these associations were not statistically significant.
This is the first study to investigate the late dose-volume effects of radiotherapy specifically on the anorectal function in rectal cancer patients. One-third of the patients had major LARS and the most frequent reported complaints were clustering and faecal urgency. Additionally, we observed trends towards worse long-term anorectal function after higher anal sphincter complex radiotherapy dose. However, this should be evaluated on a larger scale. Future efforts to minimise the dose to the sphincters could possibly reduce the impact of radiotherapy on the anorectal function.
评估直肠癌患者在接受放化疗后观察等待策略后的长期肛肠功能，并研究放疗对肛肠功能的剂量-体积效应。
纳入 33 例接受放化疗和观察等待策略治疗的原发性直肠癌患者，随访时间至少 2 年。我们使用肛肠测压和患者报告结局（Vaizey 和 LARS 评分）评估肛肠功能。计算直肠和肛门括约肌复合体的剂量-体积直方图，并评估剂量-体积参数与肛肠功能之间的相关性。
直肠和肛门括约肌复合体的 D 均为 50.5Gy 和 44.7Gy。中位随访时间为 38 个月（范围 23-116 个月），33.3%的患者报告存在主要 LARS。平均 LARS 评分为 23.4±11.3，平均 Vaizey 评分为 4.3±4.1。最常见的抱怨是排便聚集和粪便急迫。观察到肛门括约肌复合体剂量越高，Vaizey 和 LARS 评分越高的趋势，但这些相关性无统计学意义。
这是第一项专门研究直肠癌患者放疗对肛肠功能的晚期剂量-体积效应的研究。三分之一的患者存在主要的 LARS，最常见的报告症状是排便聚集和粪便急迫。此外，我们观察到肛门括约肌复合体放疗剂量越高，长期肛肠功能越差的趋势。然而，这需要在更大的范围内进行评估。未来努力减少括约肌的剂量可能会降低放疗对肛肠功能的影响。
