Department of Digestive Surgery, Akershus University Hospital, Lørenskog, Norway.
Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae091.
Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up.
All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes.
Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: -6.96 (95% c.i. -8.72 to -5.19); P < 0.001). Among patients without a stoma the mean difference was -8.1 points, whereas it was -5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group.
Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.
放疗可降低局部晚期直肠癌的局部复发率，但可能对未复发的患者造成危害。本研究旨在探讨放疗对根治性治疗后直肠癌长期生存质量的影响，即在随访期间无复发的患者。
利用挪威癌症登记处，确定 2007 年 9 月 30 日至 2020 年 10 月 1 日期间年龄在 75 岁以下接受直肠切除术的所有患者。排除标准为远处转移、复发和痴呆。主要观察指标为胃肠道生活质量指数。次要观察指标包括 36 项简短健康调查问卷。在评估结局差异时，使用基于多项逻辑回归模型的逆概率权重来平衡放疗组和无放疗组之间预先选择的协变量。
共邀请了 5014 名患者，2142 名（43%）符合条件的患者回答了问卷。其中 762 名（36%）接受新辅助放疗加手术治疗，1380 名（64%）接受单纯手术治疗。平均随访时间分别为 6.4 年和 7.4 年。在倾向评分匹配后，放疗组和非放疗组的胃肠道生活质量指数差异显著（（平均值(s.d.)，放疗组的平均评分分别为 103.8（19.4）和 110.8（19.6），平均差值为-6.96（95%可信区间-8.72 至-5.19）；P<0.001）。对于无造口的患者，平均差值为-8.1 分，而对于有造口的患者，平均差值为-5.7 分。与单纯手术组相比，放疗组在 36 项简短健康调查问卷的 8 个领域中的 7 个领域的评分也明显较低。
在随访期间无复发的患者中，与未接受放疗的患者相比，接受放疗的患者长期生活质量显著降低。这些发现需要对放疗的使用进行批判性重新评估，无论是在传统的新辅助治疗还是在现代的保器官治疗方案中。
