Impact of short-course preoperative radiotherapy for rectal cancer on patients' quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial.
OBJECTIVE
The Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 (MRC CR07/NCIC CTG C016) trial showed that, in patients with operable rectal cancer, short-course preoperative radiotherapy (PRE) reduced the rate of local recurrence compared with surgery followed by selective postoperative chemoradiotherapy for patients with a positive circumferential resection margin. However, the advantages of giving PRE to all patients needs to be balanced against any negative impact on patients' quality of life.


METHODS
All 1,350 patients were asked to complete the Medical Outcomes Study Short-Form 36-item (MOS SF-36) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Colorectal 38-item (EORTC QLQ-CR38) questionnaires. A priori hypotheses related to the impact of treatment on sexual, bowel, and physical function and general health.


RESULTS
Male sexual dysfunction was significantly increased following surgery (P < .001), although there was no difference between treatment arms. However, a treatment difference had emerged at 6 months (PRE patients reporting significantly greater dysfunction; P = .004), which persisted out to at least 2 years (an insufficient number of female patients completed the sexual dysfunction questions to draw firm conclusions). Both treatment groups reported similar levels of decreased physical function at 3 months, but thereafter it returned to baseline levels. There was no evidence of any major changes between treatments or time points in terms of general health or bowel function, but exploratory analysis indicated a significant (P = .006 at 2 years) increase in the level of fecal incontinence with PRE.


CONCLUSIONS
These results from a large randomized trial using validated patient-completed questionnaires show that, for males, the main adverse effect was sexual dysfunction, and the main cause of this was surgery, but that PRE also affected sexual and some aspects of bowel functioning.
Stephens
Richard J
RJ
Medical Research CouncilClinical Trials Unit, London, United Kingdom.
Thompson
Lindsay C
LC
Quirke
Phil
P
Steele
Robert
R
Grieve
Robert
R
Couture
Jean
J
Griffiths
Gareth O
GO
Sebag-Montefiore
David
D
D000047:Academies and Institutes; D000230:Adenocarcinoma / Q000503:physiopathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D002170:Canada; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D003672:Defecation; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology; D018714:Radiotherapy, Adjuvant; D020127:Recovery of Function; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D012735:Sexual Dysfunction, Physiological / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom