Baseline Quality of Life of Physical Function Is Highly Relevant for Overall Survival in Advanced Rectal Cancer

In advanced rectal cancer, neoadjuvant radiochemotherapy and total mesorectal excision lead to long overall survival. The quality of life (QOL) of the patients is clearly related to the prognosis. Our question was whether the prognosis can be represented with only one question or one score from the QOL questionnaires. 360 consecutively recruited patients diagnosed with advanced rectal cancer were questioned during radiochemotherapy and a follow-up of 8 years. The questionnaires QLQ-C30 and QLQ-CR38 were used; 10 functional and 17 symptom scores were calculated. The functional score “physical function” and the symptom scores “fatigue”, “nausea and vomiting”, “pain” and “appetite loss” were highly prognostic (p < 0.001) for overall survival. “Physical function” was highly prognostic at all time points up to 1 year after starting therapy (p ≤ 0.001). The baseline “physical function” score divided the cohort into a favorable group with an 8-year overall survival rate of 70.4% versus an unfavorable group with 47.5%. In the multivariable analysis, baseline “physical function”, age and distant metastases were independent predictors of overall survival. The score “physical function” is a powerful unrelated risk factor for overall survival in patients with rectal cancer. Future analyses should study whether increased “physical function” after diagnosis could improve survival.

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Liver transplantation (Ltx) in patients with nonresectable liver metastases from colorectal carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.577 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 577-577 ◽

Cited By ~ 1

Author(s):

Svein Dueland ◽

Morten Hagness ◽

Pal-Dag Line ◽

Tim Scholz ◽

P. Jorgensen ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Overall Survival ◽

Liver Metastases ◽

Physical Function ◽

Primary Tumor ◽

Palliative Chemotherapy ◽

Life Questionnaire ◽

Line Chemotherapy

577 Background: Liver resection is considered the only curative treatment of liver metastases (mets) from colo-rectal (CRC) tumors. Ltx is standard of care in selected patients with hepatocellular carcinoma, cholangiocarcinoma and neuroendocrine tumors. Patients with non-resectable liver metastases (mets) from colo-rectal cancer (CRC) receiving palliative chemotherapy have a median survival of about 2 and 1 year from start of 1. and 2. line chemotherapy, respectively. Overall 5 years survival in CRC patients after start of palliative chemotherapy is about 5-10%. In this study we examined overall survival after Ltx in selected CRC patients. The primary endpoint of the study was overall survival at 2 years after Ltx Methods: Major inclusion criteria were: non-resectable liver mets, no extra hepatic disease or local relapse determined by PET/CT scan, CT- or MRI scan and colonoscopy. No mets. on frozen section biopsies at time of surgery, ECOG 0-1, at least one line of chemotherapy for metastatic disease. Postoperative immunosuppresion: mTOR inhibitor (Rapamune), mycofpenolmofetil and tapering doses of prednisolon. Quality of life questionnaire (EORTC-C30) pre Ltx, 3, 6 and 12 months post Ltx. Results: Thirteen men and 8 women with non-resectable liver only CRC liver mets received Ltx in the period of Nov 2006 to March 2011. Median age was 56 years (range 45-65 years). Thirteen patients had colon cancer and 8 patients had rectal cancer. The T-stage of the primary tumor was T2,T3 and T4 in 2, 16 and 3 patients, respectively. N status of the primary tumor was: pN0, pN1 and pN2 all 7 patients. Nine patients had received 1.line chemotherapy and 12 patients had received 2. or 3.line therapy. The median number of liver mets was 8 (range 2-40) and the median size of the largest lesion was 4.5cm (range 2.8-13cm). The patients had good, stabile or increased Global Health Score and Physical Function at all time points after Ltx. Fifteen patients with follow-up of 2 years or more or death within 2 years of Ltx had 2 years overall survival of 87%. Conclusions: Long term survival is obtained after Ltx in selected patients with non-resectable liver mets from CRC. The patients reported good quality of life and physical function after Ltx.

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Prospective Assessment of Quality of Life in Locally Advanced Rectal Cancer Patients Receiving Chemoradiotherapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2011.06.913 ◽

2011 ◽

Vol 81 (2) ◽

pp. S666

Author(s):

J.M. Herman ◽

K.A. Griffith ◽

A.K. Narang ◽

M.M. Zalupski ◽

N.S. Azad ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Cancer Patients ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Prospective Assessment

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Acute Quality of Life (QOL) Effects of Chemoradiation Therapy (CRT) for Locally-advanced Rectal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2007.07.1319 ◽

2007 ◽

Vol 69 (3) ◽

pp. S284

Author(s):

R.C. Chen ◽

H.J. Mamon ◽

A. Niemierko ◽

E.M. Crowley ◽

W.W. Suh ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Chemoradiation Therapy

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Clinical downstaging and quality of life after neoadjuvant chemotherapy in patients with locally advanced rectal cancer: Interim analysis from a phase II clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15178 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15178-e15178

Author(s):

Ahmed Abdalla ◽

Amr M. Aref ◽

Amer Alame ◽

Danny Ma ◽

Mohammed Barawi ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Rectal Cancer ◽

Neoadjuvant Chemotherapy ◽

Phase Ii ◽

General Health ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer

e15178 Background: The role of neoadjuvant FOLFOX in achieving clinical downstaging and improvement in quality of life (QOL) in patients with locally advanced rectal cancer (LARC) remains to be established. We are conducting a phase II prospective clinical trial to evaluate the use of six cycles of FOLFOX as neoadjuvant chemotherapy in patients with T2-T3/N0-N+ rectal cancer. We now report tumor clinical downstaging and patient-reported QOL in our first patient cohort. Methods: Eleven Patients enrolled in our phase II prospective trial. Patients received three months of FOLFOX (infusional fluorouracil, leucovorin, and oxaliplatin) administered every two weeks. After three weeks of recovery, each patient was treated with conventional chemo-radiotherapy (5FU or capecitabine) All patients had an MRI and endorectal ultrasound at baseline and after completion of FOLFOX. A compilation of validated QOL questionnaires were also administered before and after FOLFOX. Results: A total of 11 patients completed the chemotherapy regimen. Based on pelvic MRI, complete clinical response (T0N0) was achieved by seven patients (64%), one patient (9%) was clinically downstaged but three (27%) didn’t have any changes following FOLFOX. Importantly, we found no disease progression during the FOLFOX course. QOL assessment after FOLFOX regimen showed trend towards improvement in general health, mobility, bladder control and psychological health. These changes in QOL were not statistically significant due to the small sample size. Patients self-grading of their general health before starting FOLFOX was 50% compared to 75% after. Of the five patients with pain at time of diagnosis, four reported complete pain relief while the fifth reported improvement from extreme to moderate pain. Three patients reported improvement in their anxiety/depression. In terms of bowel function, although there was trend towards improvement in the urgency subscale, other bowel functions subscales were unchanged. In general, scores for mobility, selfcare, and bladder function were slightly better after FOLFOX. Conclusions: This study suggests that adding only six cycles of neoadjuvant FOLFOX before CRT not only resulted in clinical downstaging of (LARC) but showed a trend toward improved QOL. This result provides some reassurance for oncologists that this approach does not diminish QOL with no risk of disease progression during the time of neoadjuvant chemotherapy. These findings need to be validated in a larger phase III trial.

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The Quality-of-Life Effects of Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.09.006 ◽

2013 ◽

Vol 85 (1) ◽

pp. e15-e19 ◽

Cited By ~ 31

Author(s):

Joseph M. Herman ◽

Amol K. Narang ◽

Kent A. Griffith ◽

Mark M. Zalupski ◽

Jennifer B. Reese ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Neoadjuvant Chemoradiation

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Influence of Gender on Radiosensitivity during Radiochemotherapy of Advanced Rectal Cancer

Cancers ◽

10.3390/cancers14010148 ◽

2021 ◽

Vol 14 (1) ◽

pp. 148

Author(s):

Barbara Schuster ◽

Markus Hecht ◽

Manfred Schmidt ◽

Marlen Haderlein ◽

Tina Jost ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Body Weight ◽

Chromosomal Aberrations ◽

Tumor Regression ◽

Tumor Infiltrating Lymphocytes ◽

Advanced Rectal Cancer ◽

The Body ◽

Infiltrating Lymphocytes

Gender is increasingly recognized as an important factor in medicine, although it has long been neglected in medical research in many areas. We have studied the influence of gender in advanced rectal cancer with a special focus on radiosensitivity. For this purpose, we studied a cohort of 495 men (84.1% ≥ T3, 63.6% N1, 17.6%, M1) and 215 women (84.2% ≥ T3, 56.7% N1, 22.8%, M1) who all suffered from advanced rectal cancer and were treated with radiochemotherapy. The energy deposited, DNA double-strand break (dsb) repair, occurrence of chromosomal aberrations, duration of therapy, tumor regression and tumor-infiltrating lymphocytes, laboratory parameters, quality of life and survival were assessed. The residual DNA dsb damage 24 h after irradiation in lymphocytes was identical in both sexes. Furthermore, chromosomal aberrations accurately reflecting radiosensitivity, were similar in both sexes. There were no gender-dependent differences in tumor regression, tumor-infiltrating lymphocytes and outcome indicating no differences in the radiosensitivity of cancer cells. The irradiated tumor volume in women was slightly lower than in men, related to body weight, no difference was observed. However, when the total energy deposited was calculated and related to the body weight, women were exposed to higher amounts of ionizing radiation. During radiochemotherapy, decreases in blood lymphocyte counts and albumin and several quality-of-life parameters such as nausea and vomiting, loss of appetite, and diarrhea were significantly worse in women. There is no difference in radiation sensitivity between men and women in both normal tissue and tumors. During radiochemotherapy, the quality of life deteriorates more in women than in men. However, women also recover quickly and there are no long-term differences in quality of life.

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Prospective assessment of symptoms and quality of life in localized rectal cancer patients receiving chemoradiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.504 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 504-504

Author(s):

J. M. Herman ◽

K. A. Griffith ◽

A. K. Narang ◽

M. M. Zalupski ◽

N. S. Azad ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Sexual Function ◽

Cancer Patients ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Gi Symptoms ◽

Grade 3

504 Background: Neoadjuvant conformal chemoradiotherapy (CRT) is an important component of treatment for locally advanced rectal cancer, yet its morbidity has not been well characterized using quality of life (QOL) instruments. The present study attempts to establish a baseline distribution of QOL scores before, during, and after CRT and to correlate these changes with symptoms. Methods: Patients undergoing 3-4 field neoadjuvant CRT for localized rectal cancer were prospectively enrolled at two institutions. Fifty patients completed the QOL instruments at three time points: pretreatment, week 4 of treatment, and 1 month post-treatment. QOL information was captured using three validated questionnaires, the EORTC QLQ-30, QLQ-38, and QLQ-29. Additionally, institutional symptom inventories and CTCAE toxicity data were collected. Results: Average age was 59.2 years and 72% were men. During CRT, patients had a statistically significant decline in global QOL (70 to 60, p = 0.0024), which normalized (71) following completion of treatment. During therapy, patients also experienced a significant increase in GI symptoms (21 to 27, p = 0.028), urinary symptoms (16 to 30, p < 0.0001), male sexual dysfunction (23 to 34, p = 0.013), and chemotherapy related side effects (8 to 20, p = 0.0001). While these measures returned to baseline 1 month post-CRT, overall sexual function (25 vs. 37, p = 0.0062) and sexual enjoyment (53 vs. 67, p = 0.0070) remained persistently low compared to pretreatment levels. Diarrhea (27%) and proctitis (22%) were the most common grade 3 toxicities. Those patients who experienced grade 3 toxicity during treatment showed markedly decreased global QOL (mean difference = 34). Conclusions: While rectal cancer patients experienced impaired QOL during neoadjuvant CRT, the vast majority of measures normalized one month after treatment. In contrast, significantly decreased sexual function and enjoyment persisted. This data can be used as a baseline to compare future neoadjuvant conformal CRT regimens and/or assess the toxicity and QOL of new RT modalities such as intensity modulated radiation therapy. No significant financial relationships to disclose.

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