title: Effects on functional outcome after IORT-containing multimodality treatment for locally advanced primary and locally recurrent rectal cancer.
abstract: OBJECTIVE
  In the treatment of patients with locally advanced primary or locally recurrent rectal cancer, much attention is focused on the oncologic outcome. Little is known about the functional outcome. In this study, the functional outcome after a multimodality treatment for locally advanced primary and locally recurrent rectal cancer is analyzed.
  
  
  METHODS
  Between 1994 and 1999, 55 patients with locally advanced primary and 66 patients with locally recurrent rectal cancer were treated with high-dose preoperative external beam irradiation, followed by extended surgery and intraoperative radiotherapy. To assess long-term functional outcome, all patients still alive (n = 97) were asked to complete a questionnaire regarding ongoing morbidity, as well as functional and social impairment. Seventy-six of the 79 patients (96%) returned the questionnaire. The median follow-up was 14 months (range: 4-60 months).
  
  
  RESULTS
  The questionnaire revealed fatigue in 44%, perineal pain in 42%, radiating pain in the leg(s) in 21%, walking difficulties in 36%, and voiding dysfunction in 42% of the patients as symptoms of ongoing morbidity. Functional impairment consisted of requiring help with basic activities in 15% and sexual inactivity in 56% of the respondents. Social handicap was demonstrated by loss of former lifestyle in 44% and loss of professional occupation in 40% of patients.
  
  
  CONCLUSIONS
  As a result of multimodality treatment, the majority of these patients have to deal with long-term physical morbidity, the need for help with daily care, and considerable social impairment. These consequences must be weighed against the chance of cure if the patient is treated and the disability eventually caused by uncontrolled tumor progression if the patient is not treated. These potential drawbacks should be discussed with the patient preoperatively and taken into account when designing a treatment strategy.
authors.affiliation: Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5631 EJ Eindhoven, The Netherlands.
authors.forename: Guido H H
authors.initials: GH
authors.lastname: Mannaerts
authors.forename: Harm J T
authors.initials: HJ
authors.lastname: Rutten
authors.forename: Hendrik
authors.initials: H
authors.lastname: Martijn
authors.forename: Patrick E J
authors.initials: PE
authors.lastname: Hanssens
authors.forename: Theo
authors.initials: T
authors.lastname: Wiggers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000628:therapy*; D012725:Sexual Behavior; D016896:Treatment Outcome