Impact of late anorectal dysfunction on quality of life after pelvic radiotherapy.
OBJECTIVE
Anorectal dysfunction is common after pelvic radiotherapy. This study aims to explore the relationship of subjective and objective anorectal function with quality of life (QoL) and their relative impact in patients irradiated for prostate cancer.


METHODS
Patients underwent anal manometry, rectal barostat measurement, and completed validated questionnaires, at least 1 year after prostate radiotherapy (range 1-7 years). QoL was measured by the Fecal Incontinence Quality of Life scale (FIQL) and the Expanded Prostate Cancer Index Composite Bowel domain (EPICB)-bother subscale. Severity of symptoms was rated by the EPICB function subscale.


RESULTS
Anorectal function was evaluated in 85 men. Sixty-three percent suffered from one or more anorectal symptoms. Correlations of individual symptoms ranged from r = 0.23 to r = 0.53 with FIQL domains and from r = 0.36 to r = 0.73 with EPICB bother scores. They were strongest for fecal incontinence and urgency. Correlations of anal sphincter pressures, rectal capacity, and sensory thresholds ranged from r = 0.00 to r = 0.42 with FIQL domains and from r = 0.15 to r = 0.31 with EPICB bother scores. Anal resting pressure correlated most strongly. Standardized regression coefficients for QoL outcomes were largest for incontinence, urgency, and anal resting pressure. Regression models with subjective parameters explained a larger amount (range 26-92 %) of variation in QoL outcome than objective parameters (range 10-22 %).


CONCLUSIONS
Fecal incontinence and rectal urgency are the symptoms with the largest influence on QoL. Impaired anal resting pressure is the objective function parameter with the largest influence. Therefore, sparing the structures responsible for an adequate fecal continence is important in radiotherapy planning.
455 Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands. r.krol@mdl.umcn.nl
Robin
R
Krol
Robert Jan
RJ
Smeenk
Emile N J T
EN
van Lin
Wim P M
WP
Hopman
D000368:Aged; D001003:Anal Canal / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010388:Pelvis / Q000503:physiopathology* / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011788:Quality of Life; D012007:Rectum / Q000503:physiopathology*; D012044:Regression Analysis; D011795:Surveys and Questionnaires