Marit E van der Sande1, Britt J P Hupkens2, Maaike Berbée3, Sander M J van Kuijk4, Monique Maas5, Jarno Melenhorst6, Geerard L Beets7, Stéphanie O Breukink8. 1. The Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands. 2. Maastricht University Medical Center+, Department of Surgery, the Netherlands; Maastricht University Medical Center+, Department of Radiology, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands. 3. Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands. 4. Maastricht University Medical Center+, Department of Clinical Epidemiology and Medical Technology Assessment, the Netherlands. 5. The Netherlands Cancer Institute, Department of Radiology, Amsterdam, the Netherlands. 6. Maastricht University Medical Center+, Department of Surgery, the Netherlands. 7. The Netherlands Cancer Institute, Department of Surgery, Amsterdam, the Netherlands; GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands. 8. Maastricht University Medical Center+, Department of Surgery, the Netherlands. Electronic address: s.breukink@mumc.nl.
Abstract
BACKGROUND AND PURPOSE: To assess the long-term anorectal function in rectal cancer patients following a watch-and-wait policy after chemoradiotherapy and to investigate the dose-volume effects of radiotherapy on the anorectal function. METHODS AND MATERIALS: Thirty-three patients with primary rectal cancer who were treated with chemoradiotherapy and a watch-and-wait policy with minimum follow-up of 2 years were included. We assessed the anorectal function using anorectal manometry and patient reported outcomes (Vaizey and LARS score). Dose-volume histograms were calculated for the rectum and anal sphincter complex, and associations between the dose-volume parameters and anorectal function were assessed. RESULTS: Dmean to the rectum and anal sphincter complex was 50.5 Gy and 44.7 Gy, respectively. After a median follow-up of 38 (range 23-116) months, 33.3% of the patients reported major LARS. Mean LARS score was 23.4 ± 11.3 and mean Vaizey score was 4.3 ± 4.1. The most frequent complaints were clustering of defaecation and faecal urgency. Trends towards a higher Vaizey and LARS score after higher anal sphincter complex dose were observed, although these associations were not statistically significant. CONCLUSIONS: This is the first study to investigate the late dose-volume effects of radiotherapy specifically on the anorectal function in rectal cancer patients. One-third of the patients had major LARS and the most frequent reported complaints were clustering and faecal urgency. Additionally, we observed trends towards worse long-term anorectal function after higher anal sphincter complex radiotherapy dose. However, this should be evaluated on a larger scale. Future efforts to minimise the dose to the sphincters could possibly reduce the impact of radiotherapy on the anorectal function.
BACKGROUND AND PURPOSE: To assess the long-term anorectal function in rectal cancerpatients following a watch-and-wait policy after chemoradiotherapy and to investigate the dose-volume effects of radiotherapy on the anorectal function. METHODS AND MATERIALS: Thirty-three patients with primary rectal cancer who were treated with chemoradiotherapy and a watch-and-wait policy with minimum follow-up of 2 years were included. We assessed the anorectal function using anorectal manometry and patient reported outcomes (Vaizey and LARS score). Dose-volume histograms were calculated for the rectum and anal sphincter complex, and associations between the dose-volume parameters and anorectal function were assessed. RESULTS: Dmean to the rectum and anal sphincter complex was 50.5 Gy and 44.7 Gy, respectively. After a median follow-up of 38 (range 23-116) months, 33.3% of the patients reported major LARS. Mean LARS score was 23.4 ± 11.3 and mean Vaizey score was 4.3 ± 4.1. The most frequent complaints were clustering of defaecation and faecal urgency. Trends towards a higher Vaizey and LARS score after higher anal sphincter complex dose were observed, although these associations were not statistically significant. CONCLUSIONS: This is the first study to investigate the late dose-volume effects of radiotherapy specifically on the anorectal function in rectal cancerpatients. One-third of the patients had major LARS and the most frequent reported complaints were clustering and faecal urgency. Additionally, we observed trends towards worse long-term anorectal function after higher anal sphincter complex radiotherapy dose. However, this should be evaluated on a larger scale. Future efforts to minimise the dose to the sphincters could possibly reduce the impact of radiotherapy on the anorectal function.
Authors: Emmanouil Fokas; Ane Appelt; Alexandra Gilbert; David Sebag-Montefiore; Claus Rödel; Robert Glynne-Jones; Geerard Beets; Rodrigo Perez; Julio Garcia-Aguilar; Eric Rullier; J Joshua Smith; Corrie Marijnen; Femke P Peters; Maxine van der Valk; Regina Beets-Tan; Arthur S Myint; Jean-Pierre Gerard; Simon P Bach; Michael Ghadimi; Ralf D Hofheinz; Krzysztof Bujko; Cihan Gani; Karin Haustermans; Bruce D Minsky; Ethan Ludmir; Nicholas P West; Maria A Gambacorta; Vincenzo Valentini; Marc Buyse; Andrew G Renehan Journal: Nat Rev Clin Oncol Date: 2021-08-04 Impact factor: 66.675
Authors: Alexander J Pennings; Merel L Kimman; Anke H C Gielen; Geerard L Beets; Jarno Melenhorst; Stephanie O Breukink Journal: Colorectal Dis Date: 2021-08-07 Impact factor: 3.917
Authors: Ane L Appelt; Ellen M Kerkhof; Lars Nyvang; Ernst C Harderwijk; Natalie L Abbott; Mark Teo; Femke P Peters; Camilla J S Kronborg; Karen-Lise G Spindler; David Sebag-Montefiore; Corrie A M Marijnen Journal: Tech Innov Patient Support Radiat Oncol Date: 2019-10-15