title: A comprehensive longitudinal overview of health-related quality of life and symptoms after treatment for rectal cancer in the TME trial.
abstract: BACKGROUND
  Total mesorectal excision (TME) combined with preoperative short-term radiotherapy (PRT) reduces local recurrence rates in rectal cancer treatment. However, treatment with radiotherapy increased morbidity and did not result in a longer survival. The aim of this analysis is to provide a comprehensive longitudinal overview of the health-related quality of life (HRQL) and symptoms experienced by rectal cancer patients in the Dutch randomized TME trial from baseline until 14 years after treatment.
  
  
  METHODS
  Rectal cancer patients (n =1530) were randomly allocated to PRT (5 × 5 Gy) followed by TME or to TME alone. At baseline, 3, 6, 12, 18, and 24 months, 5 years and 14 years after treatment HRQL was evaluated in surviving patients (n =606, at 14 years after treatment).
  
  
  RESULTS
  None of the general symptoms differed significantly between PRT + TME and TME. However, in both treatment arms the general symptoms were increased at the diagnosis of rectal cancer, after surgery and by aging. With PRT + TME bowel symptoms were increased, specifically more fecal incontinence was reported at all time points, resulting in more use of pads for fecal incontinence (PRT + TME vs. TME at 5 years 51.5% vs. 30.5%, respectively, and at 14 years 56.4% vs. 37.1%, respectively).
  
  
  CONCLUSIONS
  This longitudinal analysis shows that general symptoms in both groups are increased at the diagnosis of rectal cancer, after surgery and by aging, but not by RT. However, irradiated patients reported more bowel dysfunction at all time points.
authors.affiliation: a Department of Radiation Oncology , Leiden University Medical Center , Leiden , The Netherlands and.
authors.forename: Lisette M
authors.initials: LM
authors.lastname: Wiltink
authors.affiliation: a Department of Radiation Oncology , Leiden University Medical Center , Leiden , The Netherlands and.
authors.forename: Corrie A M
authors.initials: CA
authors.lastname: Marijnen
authors.affiliation: b Department of Surgery , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Elma
authors.initials: E
authors.lastname: Meershoek-Klein Kranenbarg
authors.affiliation: b Department of Surgery , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Cornelis J H
authors.initials: CJ
authors.lastname: van de Velde
authors.affiliation: a Department of Radiation Oncology , Leiden University Medical Center , Leiden , The Netherlands and.
authors.forename: Remi A
authors.initials: RA
authors.lastname: Nout
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*