Short- and Long-Term Quality of Life and Bowel Function in Patients With MRI-Defined, High-Risk, Locally Advanced Rectal Cancer Treated With an Intensified Neoadjuvant Strategy in the Randomized Phase 2 EXPERT-C Trial

Journal Article · Thu Oct 01 00:00:00 EDT 2015 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2015.03.038· OSTI ID:22458777

Sclafani, Francesco; Peckitt, Clare ^[1]; Cunningham, David ^[1]; Tait, Diana ^[1]; Giralt, Jordi ^[2]; Glimelius, Bengt ^[3]; Keränen, Susana Roselló ^[4]; Bateman, Andrew ^[5]; Hickish, Tamas ^[6]; Tabernero, Josep ^[2]; Thomas, Janet; Brown, Gina; Oates, Jacqueline; Chau, Ian ^[1]

---

1. The Royal Marsden NHS Foundation Trust, London (United Kingdom)
2. Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Department of Medical Oncology, Barcelona (Spain)
3. University of Uppsala, Uppsala (Sweden)
4. Biomedical Research Institute INCLIVA, Department of Hematology and Medical Oncology, University of Valencia (Spain)
5. Southampton General Hospital, Cancer Sciences Unit, University of Southampton (United Kingdom)
6. Poole Hospital NHS Foundation Trust, Department of Medical Oncology, Bournemouth University (United Kingdom)

Objective: Intensified preoperative treatments have been increasingly investigated in locally advanced rectal cancer (LARC), but limited data are available for the impact of these regimens on quality of life (QoL) and bowel function (BF). We assessed these outcome measures in EXPERT-C, a randomized phase 2 trial of neoadjuvant capecitabine combined with oxaliplatin (CAPOX), followed by chemoradiation therapy (CRT), total mesorectal excision, and adjuvant CAPOX with or without cetuximab in magnetic resonance imaging-defined, high-risk LARC. Methods and Materials: QoL was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR29 questionnaires. Bowel incontinence was assessed using the modified Fecal Incontinence Severity Index questionnaire. Results: Compared to baseline, QoL scores during preoperative treatment were better for symptoms associated with the primary tumor in the rectum (blood and mucus in stool, constipation, diarrhea, stool frequency, buttock pain) but worse for global health status, role functioning, and symptoms related to the specific safety profile of each treatment modality. During follow-up, improved emotional functioning and lessened anxiety and insomnia were observed, but deterioration of body image, increased urinary incontinence, less sexual interest (men), and increased impotence and dyspareunia were observed. Cetuximab was associated with a deterioration of global health status during neoadjuvant chemotherapy but did not have any long-term detrimental effect. An improvement in bowel continence was observed after preoperative treatment and 3 years after sphincter-sparing surgery. Conclusions: Intensifying neoadjuvant treatment by administering induction systemic chemotherapy before chemoradiation therapy improves tumor-related symptoms and does not appear to have a significantly detrimental effect on QoL and BF, in both the short and the long term.

• OSTI ID: 22458777
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 93, Issue 2; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BLOOD
CHEMOTHERAPY
COMPARATIVE EVALUATIONS
CONSTIPATION
DIARRHEA
HAZARDS
NEOPLASMS
NMR IMAGING
PAIN
PATIENTS
RECTUM
STANDARD OF LIVING
SURGERY