Abstract
Purpose
Short-course radiation therapy (SCRT) and long-course chemoradiation (LCCRT) are established preoperative strategies for rectal cancer with comparable oncologic outcomes, but longitudinal colorectal cancer-specific patient-reported outcome (PRO) data comparing them are limited. We assessed quality of life (QoL) and functional outcomes using the European Organization for Research and Treatment of Cancer colorectal cancer (EORTC QLQ-CR29) in patients treated with SCRT versus LCCRT.Methods and materials
Patients with localized rectal cancer treated with preoperative SCRT (25 Gy/5 fractions) or LCCRT (50-50.4 Gy/25-28 fractions with concurrent fluoropyrimidine) from 2013 to 2024 were identified from a prospective PRO registry. Patients completed the EORTC QLQ-CR29 at baseline, during/after radiation therapy, and postoperatively at ∼3 months, 6 months, 1 year, and 2 years. The primary outcome was change from baseline in the defecation and stoma problems subscale (DSP), and the secondary outcomes included overall EORTC QLQ-CR29 score and selected bowel, urinary, and sexual function subscales. Linear mixed models, adjusted for baseline score and high-risk disease features, were used to compare longitudinal changes.Results
Of 323 eligible patients, 206 patients completed baseline PROs (LCCRT n = 116; SCRT n = 90). Baseline EORTC QLQ-CR29 scores were comparable, although LCCRT patients were more likely to have high-risk disease features. During the preoperative period, LCCRT was associated with greater declines in DSP, overall EORTC QLQ-CR29, urinary frequency, and dysuria. Postoperatively, both cohorts demonstrated similar recovery trajectories. At 3 months, 6 months, 1 year, and 2 years, no sustained differences were observed in DSP, overall QLQ-CR29, or other subscale scores. In the low anterior resection subset, a transient detriment at 1 year in DSP and overall EORTC QLQ-CR29 was seen in the LCCRT cohort, but this did not persist at 2 years.Conclusions
Two years after surgery, long-term QoL and functional outcomes were comparable between SCRT and LCCRT, supporting shared decision-making regarding preoperative radiation therapy strategies.