腫瘍外科アーカイブ

A Comparison of Post-treatment Quality of Life Outcomes for Endoluminal Brachytherapy and Chemoradiation for the Treatment of Localized Rectal Cancer

Abstract

Azah A Althumairi, Francesca Monn, Joseph M Herman, Amol K Narang, Amy Hacker-Prietz, Jonathan E Efron, Elizabeth C Wick and Susan L Gearhart

Summary: The current study showed that short four day course endoluminal brachytherapy is an effective neoadjuvant treatment for locally advanced rectal cancer; however, it was associated with worsening post-treatment global quality of life and more gastrointestinal symptoms following treatment.
Purpose: An attractive alternative to long course neoadjuvant chemoradiation (CRT) for rectal adenocarcinoma is short four day course endoluminal brachytherapy (EBT). However, quality of life (QOL) following EBT is unknown. We aim to compare post-treatment QOL between EBT and CRT.
Methods: 17 patients with localized rectal cancer were prospectively enrolled on a pilot study of EBT. For comparison, prospectively collected QOL for 50 patients received CRT for rectal adenocarcinoma was included. QOL was measured using European Organization for Research and Treatment of Cancer (EORTC QLQ-C30 and EORTC QLQ-CR29) given to patients prior to, during, and at 3 – 6 weeks following treatment.
Results: Comparing baseline mean scores to 3 – 6 weeks following EBT treatment, patients at the end of EBT had lower means scores in global functioning (81.0 vs. 53.0, p < 0.01); role functioning (90.0 vs. 63.0, p < 0.01); social functioning (91.0 vs. 68.0, p < 0.01); increased anxiety (89.0 vs. 62.0, p < 0.01); higher scores for pain (11.0 vs. 46.9, p < 0.01); fatigue (19.3 vs. 46.2, p < 0.01); and buttock pain (17.0 vs. 62.0, p < 0.01). Compared to mean difference of scores from baseline to the end of treatment for the control group, patients undergoing EBT had worsening global functioning (28.0 vs. 0, p < 0.01); physical functioning (12.2 vs. 2.0, p < 0.01); role functioning (27.1 vs. 3.3, p < 0.01); social functioning (23.4 vs. 1.0, p < 0.01); changes in weight (28.3 vs. 1.0, p < 0.01); higher scores for pain (35.8 vs. 6.7, p < 0.01); fatigue (26.9 vs. 1.2, p < 0.01); dysuria (17.9 vs. 5.3, p < 0.01); abdominal pain (27.2 vs. 2.8, p < 0.01); and buttock pain (45.6 vs. 8.0, p < 0.01).
Conclusion: Although EBT is an effective alternative, rectal cancer patients may experience worse acute preoperative global QOL and more gastrointestinal symptoms following treatment. Efforts should be made to minimize these symptoms during treatment. Further studies are needed to determine the long-term effects of EBT on QOL.