Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer.
OBJECTIVE
In the treatment of patients with locally advanced primary or locally recurrent rectal cancer much attention is given to the oncological aspects. In long-term survivors, urogenital morbidity can have a large effect on the quality of life. This study evaluates the functional outcome after multimodality treatment in these patient groups.


METHODS
Between 1994 and August 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with multimodality treatment: i.e. high-dose preoperative external beam radiation therapy, followed by extended surgery and intraoperative radiotherapy. The medical records of the 121 patients were reviewed. To assess long-term urogenital morbidity, all patients still alive, with a minimum follow-up of 4 months, were asked to fill out a questionnaire about their voiding and sexual function. Seventy-six of the 79 currently living patients (96%) returned the questionnaire (median FU 14 months, range 4-60).


RESULTS
The questionnaire revealed identifiable voiding dysfunction as a new problem in 31% of the male and 58% of the female patients. In 42% of patients after locally advanced primary and 48% after locally recurrent rectal cancer treatment bladder dysfunction occurred. The preoperative ability to have an orgasm had disappeared in 50% of the male and 50% of the female patients, and in 45% of patients after locally advanced primary and in 57% after locally recurrent rectal cancer treatment.


CONCLUSIONS
Multimodality treatment for locally advanced primary and recurrent rectal cancer results in acceptable urogenital dysfunction if weighed by the risk of uncontrolled tumour progression. Long-term voiding and sexual function is decreased in half of the patients. Preoperative counselling of these patients on treatment-related urogenital morbidity is important.
Mannaerts
G H
GH
Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands.
Schijven
M P
MP
Hendrikx
A
A
Martijn
H
H
Rutten
H J
HJ
Wiggers
T
T
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014570:Urologic Diseases / Q000453:epidemiology* / Q000503:physiopathology