Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Clin Colorectal Cancer. 2023 Jun;22(2):211-221. doi: 10.1016/j.clcc.2023.02.003. Epub 2023 Feb 15.
Multimodality treatment for locally advanced rectal cancer (LARC) can include long-course radiotherapy (LCRT) or short course radiotherapy (SCRT). Nonoperative management is increasingly pursued for those achieving a complete clinical response. Data regarding long-term function and quality-of-life (QOL) are limited.
Patients with LARC treated with radiotherapy from 2016 to 2020 completed the Functional Assessment of Cancer Therapy- General (FACT-G7), the Low Anterior Resection Syndrome Score (LARS) and the Fecal Incontinence QOL Scale (FIQOL). Univariate and multivariable linear regression analyses identified associations between clinical variables including radiation fractionation and the use of surgery versus non-operative management.
Of 204 patients surveyed, 124 (60.8%) responded. Median (interquartile range) time from radiation to survey completion was 30.1 (18.3-43) months. Seventy-nine (63.7%) respondents received LCRT, and 45 (36.3%) received SCRT; 101 (81.5%) respondents underwent surgery, and 23 (18.5%) pursued nonoperative management. There were no differences in LARS, FIQoL or FACT-G7 between patients receiving LCRT versus SCRT. On multivariable analysis, only nonoperative management was associated with lower LARS score signifying less bowel dysfunction. Nonoperative management and female sex were associated with a higher FIQoL score signifying less disruption and distress from fecal incontinence issues. Finally, lower BMI at the time of radiation, female sex, and higher FIQoL score were associated with higher FACT-G7 scores signifying better overall QOL.
These results suggest long-term patient-reported bowel function and QOL may be similar for individuals receiving SCRT and LCRT for the treatment of LARC, but nonoperative management may lead to improved bowel function and QOL.
局部晚期直肠癌（LARC）的多模态治疗可以包括长程放疗（LCRT）或短程放疗（SCRT）。对于完全临床缓解的患者，非手术治疗越来越受到关注。关于长期功能和生活质量（QOL）的数据有限。
2016 年至 2020 年间接受放疗治疗的 LARC 患者完成了癌症治疗功能评估-一般量表（FACT-G7）、低位前切除综合征评分（LARS）和粪便失禁生活质量量表（FIQOL）。单变量和多变量线性回归分析确定了包括放疗分割和手术与非手术管理使用在内的临床变量与生活质量之间的关联。
在接受调查的 204 名患者中，有 124 名（60.8%）做出了回应。从放疗到调查完成的中位（四分位距）时间为 30.1（18.3-43）个月。79 名（63.7%）患者接受了 LCRT，45 名（36.3%）患者接受了 SCRT；101 名（81.5%）患者接受了手术，23 名（18.5%）患者选择了非手术管理。接受 LCRT 与 SCRT 的患者之间的 LARS、FIQoL 或 FACT-G7 无差异。多变量分析表明，只有非手术管理与较低的 LARS 评分相关，提示肠道功能障碍较轻。非手术管理和女性与较高的 FIQoL 评分相关，提示粪便失禁问题的破坏和困扰较小。最后，放疗时较低的 BMI、女性和较高的 FIQoL 评分与较高的 FACT-G7 评分相关，提示整体 QOL 较好。
这些结果表明，接受 SCRT 和 LCRT 治疗 LARC 的患者长期患者报告的肠道功能和 QOL 可能相似，但非手术治疗可能会改善肠道功能和 QOL。
Zotero 插件