Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
Division of Radiation Oncology, Department of Oncology, University of Alberta & Cross Cancer Institute, Edmonton, Alberta, Canada.
Int J Radiat Oncol Biol Phys. 2023 Oct 1;117(2):434-445. doi: 10.1016/j.ijrobp.2023.04.023. Epub 2023 May 4.
Intensity modulated radiation therapy (IMRT) has confirmed its superiority in improving acute treatment-related toxicities in anal cancer, without compromising tumor control. However, the effect of IMRT on long-term quality of life (QOL) is poorly documented. The study prospectively evaluated the long-term patient-reported QOL after IMRT-based chemoradiation in anal cancer.
Fifty-eight patients treated with IMRT and concurrent 5 fluorouracil/mitomycin-C were enrolled in the study. A prespecified secondary endpoint was prospective evaluation of long-term QOL. Fifty-four patients underwent QOL evaluation at baseline, after treatment, and during follow-up until 60 months, with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) scales and the Colorectal Cancer-Specific Quality Of Life Questionnaire (QLQ-CR29) scales. The QOL scores at baseline and posttreatment periods were compared.
For QLQ-C30, at 60 months, the mean scores of global health status, all functional scales, and all symptoms except diarrhea had improved, indicating normalization of QOL. Clinically and statistically significant improvements in the global health status (15.4; P = .003), role functioning (19.3; P = .0017), emotional functioning (18.9; P = .008), and social functioning (29.8; P ≤ .001) were observed. Diarrhea persisted as a concern over the years (P = .172). For European Organization for Research and Treatment of Cancer QLQ-CR29, rectal pain (-38.6; P = .001), mucous or blood discharge per rectum (-22.8; P = .005), and perianal soreness (-37.3; P ≤ .001) were improved both clinically and statistically. Clinically significant fecal leakage was reported by 16% of patients (5.6; P = .421). Volumes receiving 45 and 54 Gy were independent predictors for fecal incontinence. Clinically and statistically significant urinary incontinence occurred in 21% of patients (17.5; P = .014). Deterioration of dyspareunia was clinically significant (26.7; P = .099) at 60 months.
Compared with historical data, IMRT is associated with reduced long-term effects on QOL. The majority of patients treated with IMRT experienced clinically significant recovery of function and improvement in QOL over 5 years after completion of treatment. Specific toxicities such as chronic diarrhea, fecal incontinence, and urinary and sexual dysfunction were primarily responsible for deterioration of the long-term QOL. Future research aimed at reducing such toxicities is needed to further improve long-term QOL in anal cancer.
调强放疗（IMRT）已证实可改善肛门癌治疗相关的急性毒性，而不影响肿瘤控制。然而，IMRT 对长期生活质量（QOL）的影响记录甚少。本研究前瞻性评估了肛门癌 IMRT 联合放化疗后患者的长期报告 QOL。
58 例接受 IMRT 和同步氟尿嘧啶/丝裂霉素 C 治疗的患者入组本研究。预先设定的次要终点是长期 QOL 的前瞻性评估。54 例患者在基线、治疗后和随访期间（直至 60 个月）接受欧洲癌症研究与治疗组织生活质量问卷-C30（EORTC QLQ-C30）量表和结直肠癌特定生活质量问卷（QLQ-CR29）量表的 QOL 评估。比较基线和治疗后期间的 QOL 评分。
对于 QLQ-C30，在 60 个月时，全球健康状况、所有功能量表和除腹泻外的所有症状的平均评分均有所改善，表明 QOL 正常化。全球健康状况（15.4；P=0.003）、角色功能（19.3；P=0.0017）、情感功能（18.9；P=0.008）和社会功能（29.8；P≤0.001）方面观察到有临床和统计学意义的改善。腹泻多年来一直是一个问题（P=0.172）。对于欧洲癌症研究与治疗组织 QLQ-CR29，直肠疼痛（-38.6；P=0.001）、直肠黏液或血液排出（-22.8；P=0.005）和肛周疼痛（-37.3；P≤0.001）在临床上和统计学上均有改善。16%的患者报告有明显的粪便渗漏（5.6；P=0.421）。接受 45 和 54 Gy 的体积是粪便失禁的独立预测因子。21%的患者出现有临床意义的尿失禁（17.5；P=0.014）。60 个月时，性交困难的恶化具有临床意义（26.7；P=0.099）。
与历史数据相比，IMRT 与 QOL 的长期影响降低相关。接受 IMRT 治疗的大多数患者在治疗结束后 5 年内经历了功能的临床显著恢复和 QOL 的改善。慢性腹泻、粪便失禁、尿失禁和性功能障碍等特定毒性是导致长期 QOL 恶化的主要原因。需要进一步研究减少这些毒性的方法，以进一步提高肛门癌的长期 QOL。
