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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2019

01-03-2019 | Health Services Research and Global Oncology

Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial

Authors: Weipeng Sun, MD, Ruoxu Dou, MD, PhD, Jiaohua Chen, MD, Sicong Lai, MD, Chi Zhang, PhD, Lei Ruan, BN, Liang Kang, MD, Yanhong Deng, MD, Ping Lan, MD, Lei Wang, MD, PhD, Jianping Wang, MD, PhD

Published in: Annals of Surgical Oncology | Issue 3/2019

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Abstract

Background

Neoadjuvant radiation is recommended for locally advanced rectal cancer, with proven benefit in local control but not in disease-free survival. However, the impact of long-course radiation on postoperative bowel function and quality of life (QOL) remains controversial. This study aimed to investigate the impact of long-course neoadjuvant radiation on bowel function and QOL, and to identify risk factors for severe bowel dysfunction.

Methods

Patients who underwent long-course neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT) followed by radical low anterior resection for locally advanced rectal cancer were recruited from the FOWARC randomized controlled trial. Low anterior resection syndrome (LARS) score and European Organisation for Research and Treatment of Cancer (EORTC) C30/CR29 questionnaires were used to assess bowel function and QOL, respectively.

Results

Overall, 220 patients responded after a median follow-up of 40.2 months, of whom 119 (54.1%) reported major LARS, 74 (33.6%) reported minor LARS, and 27 (12.3%) reported no LARS. Compared with the nCT group, the nCRT group reported more major LARS (64.4% vs. 38.6%, p < 0.001) and worse QOL. Long-course neoadjuvant radiation (OR 2.20, 95% CI 1.24–3.91; p = 0.007), height of anastomosis (OR 0.74, 95% CI 0.63–0.88; p < 0.001), and diverting ileostomy (OR 2.59, 95% CI 1.27–5.30; p = 0.009) were independent risk factors for major LARS.

Conclusions

Long-course neoadjuvant radiation, along with low anastomosis, are likely independent risk factors for postoperative bowel function and QOL. Our findings might have implications for alleviating LARS and improving QOL by informing selection of neoadjuvant treatment.
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Metadata
Title
Impact of Long-Course Neoadjuvant Radiation on Postoperative Low Anterior Resection Syndrome and Quality of Life in Rectal Cancer: Post Hoc Analysis of a Randomized Controlled Trial
Authors
Weipeng Sun, MD
Ruoxu Dou, MD, PhD
Jiaohua Chen, MD
Sicong Lai, MD
Chi Zhang, PhD
Lei Ruan, BN
Liang Kang, MD
Yanhong Deng, MD
Ping Lan, MD
Lei Wang, MD, PhD
Jianping Wang, MD, PhD
Publication date
01-03-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-07096-8

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