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

Francesco Sclafani, Clare Peckitt, David Cunningham, Diana Tait, Jordi Giralt, Bengt Glimelius, Susana Roselló Keränen, Andrew Bateman, Tamas Hickish, Josep Tabernero, Janet Thomas, Gina Brown, Jacqueline Oates, Ian Chau

Research output: Contribution to journalArticleResearchpeer-review

10 Citations (Scopus)

Abstract

© 2015 Elsevier Inc. All rights reserved. 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.
Original languageEnglish
Pages (from-to)303-312
JournalInternational Journal of Radiation Oncology Biology Physics
Volume93
Issue number2
DOIs
Publication statusPublished - 1 Jan 2015

Fingerprint Dive into the research topics of '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'. Together they form a unique fingerprint.

Cite this