Danish Center for Particle Therapy, Aarhus University Hospital, Denmark.
Department of Surgery, Aarhus University Hospital, Denmark.
Radiother Oncol. 2021 Apr;157:141-146. doi: 10.1016/j.radonc.2021.01.027. Epub 2021 Feb 3.
Chemoradiotherapy is the primary treatment for localized anal cancer (AC). This treatment offers high rates of cure and organ preservation. Radiotherapy can however, result in late persisting anorectal dysfunction, with anal incontinence, urge and clustering. Correlation of radiation doses to pelvic substructures and functional outcome is not well described in AC. We correlated patient reported anorectal function to radiation doses to sphincters and pelvic floor muscles.
Patients treated with (chemo)radiotherapy for AC were asked to fill out LARS (lower anterior resection syndrome) questionnaires at follow-up. We compared patients with no LARS (score 0-19) and patients with major LARS (30-42) as well as individual LARS questions to specific radiation doses to sphincters, levators and puborectal muscles.
Thirty-six patients were included, 18 with no LARS and 18 with major LARS. Gender, age, TNM stage, PTV, chemotherapy, time to LARS score (mean 660 and 749 days) were comparable between the two groups. LARS symptoms, occurring at least once per week, were reported between 25-55.7%, and poorer LARS outcome was associated to worse quality of life. Dose to sphincter complex (Dmean, V50Gy and D90%) differed significantly between patients with no and major LARS (p = 0.048, 0.035 and 0.02 respectively). Further, D90% to the sphincter complex was significantly higher in patients who had accidental leakage of stool, (p = 0.044).
Patients treated with (chemo)radiotherapy for AC show high frequency of patient reported anorectal dysfunction. Specific doses to the sphincters could become a useful predictor of anal incontinence and major LARS and incorporated into future radiotherapy planning studies.
放化疗是局部肛门癌（AC）的主要治疗方法。这种治疗方法提供了高的治愈率和器官保留率。然而，放疗可能导致晚期持续的肛肠功能障碍，包括肛门失禁、急迫感和聚集感。AC 中，放射剂量与盆腔亚结构和功能结果的相关性尚未得到很好的描述。我们将患者报告的肛肠功能与肛门括约肌和盆底肌肉的放射剂量相关联。
接受（放化疗）治疗的 AC 患者在随访时填写 LARS（低位前切除术综合征）问卷。我们比较了无 LARS（评分 0-19）和有 LARS（30-42）的患者，以及个别 LARS 问题与肛门括约肌、提肛肌和耻骨直肠肌的特定放射剂量。
共纳入 36 例患者，18 例无 LARS，18 例有 LARS。两组间的性别、年龄、TNM 分期、PTV、化疗、出现 LARS 评分的时间（平均 660 和 749 天）相似。至少每周出现一次的 LARS 症状报告发生率为 25-55.7%，较差的 LARS 结局与较差的生活质量相关。无 LARS 和有 LARS 的患者之间，括约肌复合体的剂量（Dmean、V50Gy 和 D90%）有显著差异（p=0.048、0.035 和 0.02）。此外，在有粪便意外渗漏的患者中，括约肌复合体的 D90%明显更高（p=0.044）。
接受（放化疗）治疗的 AC 患者报告肛肠功能障碍的频率较高。对括约肌的特定剂量可能成为肛门失禁和严重 LARS 的有用预测指标，并纳入未来的放射治疗计划研究。
