Research progress of whether neoadjuvant chemoradiotherapy affects patients’ anal function and quality of life after rectal cancer surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

AN Limin ^1,2 , YU Ruixuan ^1,2 ,  WANG Xiaodong ¹ , LI Li ¹

1. Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Xiaodong, Email: lockwan@163.com

Keywords：

rectal cancer; neoadjuvant therapy; chemotherapy; radiotherapy; rectal anterior resection syndrome

DOI：

10.7507/1007-9424.201903040

Video：

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Objective To analyze whether neoadjuvant chemoradiotherapy can impact patients’ anal function and quality of life after rectal cancer surgery.Method The domestic and international publications on the studies how the neoadjuvant chemoradiotherapy impacted patients’ anal function and quality of life were collected and reviewed.Results The neoadjuvant chemoradiotherapy negatively impacted the patients’ anal function and quality of life, but which would be improved over time. The impact had no obvious difference between the long-course chemoradiotherapy and short-couse radiotherapy on the patients’ anal function and quality of life. Compared with the neoadjuvant chemoradiotherapy, the neoadjuvant chemotherapy might impact less on the anal function, but which still needed to evaluate the lower anterior resection syndrome (LARS) score. In present, it lacked evidence of a higher rate of anastomotic leakage caused by the neoadjuvant chemoradiotherapy, which might lead to the bowel dysfunction.Conclusions Neoadjuvant chemoradiotherapy negatively impacts patients’ anal function and quality of life. Further studies are needed to figure out the best choice between long-course neoadjuvant chemoradiotherapy and short-couse radiotherapy. In long term, impact of neoadjuvant therapy can be improved over time and be accepted by patients. Some intervention treatments including medicine and operations are needed if major LARS occurs.

Citation： AN Limin, YU Ruixuan, WANG Xiaodong, LI Li. Research progress of whether neoadjuvant chemoradiotherapy affects patients’ anal function and quality of life after rectal cancer surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1355-1360. doi: 10.7507/1007-9424.201903040 Copy

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1. Ma B, Gao P, Song Y, et al. Short-course radiotherapy in neoadjuvant treatment for rectal cancer: a systematic review and meta-analysis. Clin Colorectal Cancer, 2018, 17(4): 320-330.
2. Deng Y, Chi P, Lan P, et al. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: Initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase Ⅲ trial. J Clin Oncol, 2016, 34(27): 3300-3307.
3. Glynne-Jones R, Hall MR, Lopes A, et al. BACCHUS: A randomised non-comparative phase Ⅱ study of neoadjuvant chemotherapy (NACT) in patients with locally advanced rectal cancer (LARC). Heliyon, 2018, 4(9): e00804.
4. Chetty R, McCarthy AJ. Neoadjuvant chemoradiation and rectal cancer. J Clin Pathol, 2019, 72(2): 97-101.
5. Markovina S, Youssef F, Roy A, et al. Improved metastasis- and disease-free survival with preoperative sequential short-course radiation therapy and FOLFOX chemotherapy for rectal cancer compared with neoadjuvant long-course chemoradiotherapy: results of a matched pair analysis. Int J Radiat Oncol Biol Phys, 2017, 99(2): 417-426.
6. Okuyama T, Sameshima S, Takeshita E, et al. Therapeutic effects of oxaliplatin-based neoadjuvant chemotherapy and chemor-adiotherapy in patients with locally advanced rectal cancer: a single-center, retrospective cohort study. World J Surg Oncol, 2018, 16(1): 105.
7. Yu X, Wang QX, Xiao WW, et al. Neoadjuvant oxaliplatin and capecitabine combined with bevacizumab plus radiotherapy for locally advanced rectal cancer: results of a single-institute phase Ⅱ study. Cancer Commun (Lond), 2018, 38(1): 24.
8. Li CC, Liang JA, Chung CY, et al. Effectiveness of intensity-modulated radiotherapy for rectal cancer patients treated with neoadjuvant concurrent chemoradiotherapy: a population-based propensity score-matched analysis. Anticancer Res, 2019, 39(3): 1479-1484.
9. Bohlok A, Hendlisz A, Bouazza F, et al. The potential benefit of adjuvant chemotherapy in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy is not predicted by tumor regression grade. Int J Colorectal Dis, 2018, 33(10): 1383-1391.
10. Ciammella P, Ruggieri MP, Galeandro M, et al. Short-course preoperative radiotherapy combined with chemotherapy in resectable locally advanced rectal cancer: local control and quality of life. Radiol Med, 2013, 118(8): 1397-1411.
11. Zhong X, Wu Z, Gao P, et al. The efficacy of adding targeted agents to neoadjuvant therapy for locally advanced rectal cancer patients: a meta-analysis. Cancer Med, 2018, 7(3): 565-582.
12. Ludmir EB, Palta M, Willett CG, et al. Total neoadjuvant therapy for rectal cancer: An emerging option. Cancer, 2017, 123(9): 1497-1506.
13. 马连港, 王振军. 直肠癌新辅助放化疗后效果评价与外科治疗策略. 中华胃肠外科杂志, 2018, 21(1): 23-28.
14. Dahlberg M, Glimelius B, Graf W, et al. Preoperative irradiation affects functional results after surgery for rectal cancer: results from a randomized study. Dis Colon Rectum, 1998, 41(5): 543-551.
15. Trenti L, Galvez A, Biondo S, et al. Quality of life and anterior resection syndrome after surgery for mid to low rectal cancer: A cross-sectional study. Eur J Surg Oncol, 2018, 44(7): 1031-1039.
16. Croese AD, Zubair ON, Lonie J, et al. Prevalence of low anterior resection syndrome at a regional Australian centre. ANZ J Surg, 2018, 88(12): E813-E817.
17. Quezada-Diaz F, Jimenez-Rodriguez RM, Pappou EP, et al. Effect of neoadjuvant systemic chemotherapy with or without chemoradiation on bowel function in rectal cancer patients treated with total mesorectal Excision. J Gastrointest Surg, 2019, 23(4): 800-807.
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20. Jimenez-Gomez LM, Espin-Basany E, Trenti L, et al. Factors associated with low anterior resection syndrome after surgical treatment of rectal cancer. Colorectal Dis, 2017 Sep 29. doi: 10.1111/codi.13901.
21. Keane C, Wells C, O’Grady G, et al. Defining low anterior resection syndrome: a systematic review of the literature. Colorectal Dis, 2017, 19(8): 713-722.
22. Hughes DL, Cornish J, Morris C, et al. Functional outcome following rectal surgery—predisposing factors for low anterior resection syndrome. Int J Colorectal Dis, 2017, 32(5): 691-697.
23. Mariette C, Brouquet A, Tzanis D, et al. What is the impact of neoadjuvant chemoradiation on outcomes in gastro-intestinal cancer? J Visc Surg, 2017, 154(3): 185-195.
24. Beppu N, Matsubara N, Kakuno A, et al. Feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer. Dis Colon Rectum, 2015, 58(5): 479-487.
25. Canda AE, Terzi C, Gorken IB, et al. Effects of preoperative chemoradiotherapy on anal sphincter functions and quality of life in rectal cancer patients. Int J Colorectal Dis, 2010, 25(2): 197-204.
26. Lim JF, Tjandra JJ, Hiscock R, et al. Preoperative chemoradiation for rectal cancer causes prolonged pudendal nerve terminal motor latency. Dis Colon Rectum, 2006, 49(1): 12-19.
27. Bruheim K, Guren MG, Skovlund E, et al. Late side effects and quality of life after radiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys, 2010, 76(4): 1005-1011.
28. Brændengen M, Tveit KM, Bruheim K, et al. Late patient-reported toxicity after preoperative radiotherapy or chemoradiotherapy in nonresectable rectal cancer: results from a randomized Phase Ⅲ study. Int J Radiat Oncol Biol Phys, 2011, 81(4): 1017-1024.
29. Bondeven P, Emmertsen KJ, Laurberg S, et al. Neoadjuvant therapy abolishes the functional benefits of a larger rectal remnant, as measured by magnetic resonance imaging after restorative rectal cancer surgery. Eur J Surg Oncol, 2015, 41(11): 1493-1499.
30. Lynn PB, Renfro LA, Carrero XW, et al. Anorectal function and quality of life in patients with early stage rectal cancer treated with chemoradiation and local excision. Dis Colon Rectum, 2017, 60(5): 459-468.
31. Pollack J, Holm T, Cedermark B, et al. Long-term effect of preoperative radiation therapy on anorectal function. Dis Colon Rectum, 2006, 49(3): 345-352.
32. Qin Q, Huang B, Cao W, et al. Bowel dysfunction after low anterior resection with neoadjuvant chemoradiotherapy or chemotherapy alone for rectal cancer: a cross-sectional study from China. Dis Colon Rectum, 2017, 60(7): 697-705.
33. Bregendahl S, Emmertsen KJ, Lous J, et al. Bowel dysfunction after low anterior resection with and without neoadjuvant therapy for rectal cancer: a population-based cross-sectional study. Colorectal Dis, 2013, 15(9): 1130-1139.
34. Ihnát P, Slívová I, Tulinsky L, et al. Anorectal dysfunction after laparoscopic low anterior rectal resection for rectal cancer with and without radiotherapy (manometry study). J Surg Oncol, 2018, 117(4): 710-716.
35. Birgisson H, Påhlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol, 2005, 23(34): 8697-8705.
36. Battersby NJ, Juul T, Christensen P, et al. Predicting the risk of bowel-related quality-of-life impairment after restorative resection for rectal cancer: a multicenter cross-sectional study. Dis Colon Rectum, 2016, 59(4): 270-280.
37. 黎健霞, 邓艳红, 汪建平. 直肠癌新辅助治疗方案选择: 单纯化疗或同步放化疗. 中华胃肠外科杂志, 2018, 21(6): 627-631.
38. Mowery YM, Salama JK, Zafar SY, et al. Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States. Cancer, 2017, 123(8): 1434-1441.
39. Ma B, Xu Q, Song Y, et al. Current issues of preoperative radio(chemo)therapy and its future evolution in locally advanced rectal cancer. Future Oncol, 2017, 13(27): 2489-2501.
40. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol, 2004, 72(1): 15-24.
41. Cellier P, Leduc B, Martin L, et al. Phase Ⅱ study of preoperative radiation plus concurrent daily tegafur-uracil (UFT) with leucovorin for locally advanced rectal cancer. BMC Cancer, 2011, 11: 98.
42. Landry JC, Feng Y, Cohen SJ, et al. Phase 2 study of preoperative radiation with concurrent capecitabine, oxaliplatin, and bevacizumab followed by surgery and postoperative 5-fluorouracil, leucovorin, oxaliplatin (FOLFOX), and bevacizumab in patients with locally advanced rectal cancer: ECOG 3204. Cancer, 2013, 119(8): 1521-1527.
43. Roselló S, Frasson M, García-Granero E, et al. Integrating downstaging in the risk assessment of patients with locally advanced rectal cancer treated with neoadjuvant chemor-adiotherapy: Validation of Valentini’s Nomograms and the Neoadjuvant Rectal Score. Clin Colorectal Cancer, 2018, 17(2): 104-112.
44. Lupattelli M, Matrone F, Gambacorta MA, et al. Preoperative intensity-modulated radiotherapy with a simultaneous integrated boost combined with Capecitabine in locally advanced rectal cancer: short-term results of a multicentric study. Radiat Oncol, 2017, 12(1): 139.
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Research progress of whether neoadjuvant chemoradiotherapy affects patients’ anal function and quality of life after rectal cancer surgery

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