KEY POINTS
- This prospective registry analysis included 206 patients with localized rectal adenocarcinoma who completed baseline EORTC QLQ-CR29 questionnaires: 116 received long-course chemoradiation and 90 received short-course RT.
- Short-course treatment consisted of 25 Gy in 5 fractions, whereas long-course chemoradiation delivered 50–50.4 Gy in 25–28 fractions with concurrent fluoropyrimidine. All patients subsequently underwent total mesorectal excision.
- Treatment selection was not randomized. The long-course cohort had substantially more high-risk disease, including T4 disease in 30% versus 10%, N2 disease in 37% versus 13%, and threatened mesorectal fascia in 49% versus 22%.
- Before surgery, long-course chemoradiation produced greater patient-reported deterioration. A clinically meaningful worsening in the overall QLQ-CR29 score occurred in 38% versus 14%, urinary frequency in 54% versus 25%, and dysuria in 43% versus 4% after long- versus short-course treatment.
- These acute differences did not persist. At 3 months, 6 months, 1 year and 2 years after surgery, longitudinal modeling showed no sustained difference between treatment strategies in overall QLQ-CR29, defecation/stoma problems or the other assessed bowel and urinary domains.
- In patients undergoing low anterior resection, long-course treatment showed a transient disadvantage in defecation/stoma problems and overall QLQ-CR29 at 1 year, but the difference had disappeared by 2 years.
- Functional trajectories were clinically informative regardless of RT schedule. Bowel/stoma problems worsened after treatment and surgery before stabilizing around 1–2 years; urinary function largely returned toward baseline, while male impotence continued to worsen over time in both groups.
- Interpretation is limited by nonrandomized treatment selection and declining questionnaire completion over time. Only 42 long-course and 15 short-course patients contributed overall QLQ-CR29 data at the 2-year assessment.
CLINICAL TAKEAWAY
For patients proceeding to surgery for rectal cancer, concerns about worse long-term quality of life should not by themselves drive the choice between short-course RT and long-course chemoradiation. Long-course treatment produced more acute symptom burden, but patient-reported outcomes were broadly comparable by two years, leaving oncologic risk and treatment logistics as the more important differentiators.
SOURCE
International Journal of Radiation Oncology, Biology, Physics