Pre- Versus Postoperative Pelvic Radiotherapy in Patients Undergoing Abdominoperineal Resections for Rectal Cancer: Does Timing Make a Difference On Long-Term Patient Quality of Life?
Michael S. Kasparek*1,2, Imran Hassan3, Robert R. Cima1, David W. Larson1, Eric J. Dozois1, Rachel E. Gullerud4, Dirk R. Larson4, John H. Pemberton1, Bruce G. Wolff1
1Department of Colorectal Surgery, Mayo Clinic Rochester, Rochester, MN; 2Department of Surgery, Ludwig-Maximilians-University Munich, Munich, Germany; 3Department of General Surgery, Southern Illinois University School of Medicine, Springfield, IL; 4Division of Biostatistics, Mayo Clinic Rochester, Rochester, MN
Pelvic radiotherapy (XRT) whether given pre- or postoperatively is associated with improved oncologic outcomes in patients (pts) undergoing abdominoperineal resection (APR) for locally advanced rectal cancer. However, few reports have compared quality of life (QOL) of pts after preoperative (preop) or postoperative (postop) XRT and APR.
Methods: At a single institution between 1994-2004, 204 pts underwent APR for rectal cancer and received XRT (112 preop and 92 postop). One hundred and twenty nine (63%) pts were alive at last follow-up and mailed the EORTC QLQ-C30 and EORTC QLQ-CR38. Response rate was 68% (53 preop and 35 postop XRT) and not different between the two groups (69% vs. 67% p=0.86). Median follow-up was 77 months (mo) (range 25-148 mo). Responders had a higher proportion of males (70% vs. 54%, p=0.06) but were similar in age (59 vs. 62 years, p=0.16) compared to non responders. Data are on a 0-100 point scale [100=best (functional scales) or worst (symptom scales); mean(SD)].
Results: Pts receiving preop XRT had a higher proportion of males (77% vs. 60%, p=0.08 ) and a shorter median follow-up (62 vs. 103 mo, p<0.001) compared to pts receiving postop XRT; however, the mean age (58 vs. 60 years, p=0.73) was similar. There were no significant clinical differences between the two groups in any of the symptom and functional subscales of the EORTC QLQ-C30 and EORTC QLQ-CR38 except GI tract symptoms which was worse in pts receiving preop XRT (20(16) vs. 12(12), p=0.01).
Conclusion: Among APR pts receiving XRT for locally advanced rectal cancer, timing of XRT (preop or postop) does not affect long-term patient QOL. These findings are important for counselling pts with locally advanced rectal cancer requiring an APR and XRT.
| Postoperative XRT(n=35)mean(SD) | Preoperative XRT(n=53)mean(SD) | p | |
| EORTC QLQ-C30 | |||
| Global health status | 74(17) | 68(21) | .16 |
| FS: Physical functioning | 88(17) | 84(19) | .38 |
| FS: Role functioning | 87(21) | 77(31) | .21 |
| SS: Nausea and vomiting | 4(9) | 6(12) | .61 |
| SS:Appetite loss | 7(14) | 12(21) | .35 |
| SS: Constipation | 11(20) | 14(24) | .86 |
| SS: Diarrhoea | 15(22) | 19(26) | .56 |
| EORTC QLQ-CR38 | |||
| FS: Sexual functioning: Males | 76(22) | 72(24) | 52 |
| FS: Sexual functioning: Females | 92(16) | 85(17) | .17 |
| FS: Sexual enjoyment: Males | 57(16) | 44(28) | .33 |
| FS: Sexual enjoyment: Females | 56(38) | 100(0) | .18 |
| SS: Micturition problems: Males | 24(15) | 26(21) | 0.90 |
| SS: Micturition problems: Females | 16(14) | 17(14) | .96 |
| SS: Symptoms of GI-tract | 12(22) | 20(16) | .01 |
| SS: Stoma-related problems | 27(21) | 32(23) | .34 |
FS: functionalscale; SS: symptomscale
