Late side effects and quality of life after radiotherapy for rectal cancer.
OBJECTIVE
There is little knowledge on long-term morbidity after radiotherapy (50 Gy) and total mesorectal excision for rectal cancer. Therefore, late effects on bowel, anorectal, and urinary function, and health-related quality of life (QoL), were studied in a national cohort (n = 535).


METHODS
All Norwegian patients who received pre- or postoperative (chemo-)radiotherapy for rectal cancer from 1993 to 2003 were identified. Patients treated with surgery alone served as controls. Patients were without recurrence or metastases. Bowel and urinary function was scored with the LENT SOMA scale and the St. Marks Score for fecal incontinence and QoL with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30).


RESULTS
Median time since surgery was 4.8 years. Radiation-treated (RT+) patients (n = 199) had increased bowel frequency compared with non-radiation-treated (RT-) patients (n = 336); 19% vs. 6% had more than eight daily bowel movements (p < 0.001). In patients without stoma, a higher proportion of RT+ (n = 69) compared with RT- patients (n = 240), were incontinent for liquid stools (49% vs. 15%, p < 0.001), needed a sanitary pad (52% vs. 13%, p < 0.001), and lacked the ability to defer defecation (44% vs. 16%, p < 0.001). Daily urinary incontinence occurred more frequently after radiotherapy (9% vs. 2%, p = 0.001). Radiation-treated patients had worse social function than RT- patients, and patients with fecal or urinary incontinence had impaired scores for global quality of life and social function (p < 0.001).


CONCLUSIONS
Radiotherapy for rectal cancer is associated with considerable long-term effects on anorectal function, especially in terms of bowel frequency and fecal incontinence. RT+ patients have worse social function, and fecal incontinence has a negative impact on QoL.
Bruheim
Kjersti
K
The Cancer Centre, Oslo University Hospital, Ullevål, 0407 Oslo, Norway. Kjersti.Bruheim@medisin.uio.no
Guren
Marianne G
MG
Skovlund
Eva
E
Hjermstad
Marianne J
MJ
Dahl
Olav
O
Frykholm
Gunilla
G
Carlsen
Erik
E
Tveit
Kjell Magne
KM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D003672:Defecation / Q000528:radiation effects; D019583:Dose Fractionation, Radiation; D005242:Fecal Incontinence / Q000209:etiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D018579:Patient Selection; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D012007:Rectum / Q000601:surgery; D012044:Regression Analysis; D054047:Surgical Stomas; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology*