title: Late adverse effects of short-course preoperative radiotherapy in rectal cancer.
abstract: BACKGROUND
  Preoperative radiotherapy improves local control and survival in rectal cancer, but there are few reports on long-term morbidity. The aims of this study were to compare long-term morbidity and quality of life in patients undergoing rectal cancer surgery with or without preoperative radiotherapy.
  
  
  METHODS
  A total of 252 patients, randomized within the two Stockholm trials on preoperative radiotherapy in rectal cancer, were alive at a mean of 15 years after surgery. Some 139 of these patients were available for follow-up by questionnaires and clinical examination. Questionnaires regarding medical history and quality of life were completed by all patients. All patients had a clinical examination, and those without a stoma underwent rigid sigmoidoscopy.
  
  
  RESULTS
  Overall, patients who had preoperative radiotherapy experienced significantly more late complications than those who did not (69 versus 43 per cent; P = 0.002). This morbidity consisted mainly of cardiovascular disease (35 versus 19 per cent; P = 0.032), faecal incontinence (12 of 21 versus 11 of 42 patients having anterior resection; P = 0.013) and urinary incontinence (45 versus 27 per cent; P = 0.023). No significant differences between groups were found for hip or pelvic fractures, small bowel obstruction or global quality of life.
  
  
  CONCLUSIONS
  Preoperative short-course, high-dose radiotherapy in patients with rectal cancer increases the risk of anal and urinary dysfunction, and may lead to increased cardiovascular morbidity, at long-term follow-up.
authors.affiliation: Karolinska Institute Divisions of Surgery at Danderyd Hospital, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Pollack
authors.forename: T
authors.initials: T
authors.lastname: Holm
authors.forename: B
authors.initials: B
authors.lastname: Cedermark
authors.forename: D
authors.initials: D
authors.lastname: Altman
authors.forename: B
authors.initials: B
authors.lastname: Holmström
authors.forename: B
authors.initials: B
authors.lastname: Glimelius
authors.forename: A
authors.initials: A
authors.lastname: Mellgren
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000009:adverse effects; D011446:Prospective Studies; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D014549:Urinary Incontinence / Q000209:etiology