Long-Term Patient-Reported Quality of Life of Anal Cancer Survivors Treated with Intensity Modulated Radiation Therapy and Concurrent Chemotherapy: Results from a Prospective Phase II trial
Mené sur 58 patients atteints d'un cancer anal, cet essai de phase II évalue la qualité de vie jusqu'à 60 mois après un traitement combinant une radiothérapie avec modulation d'intensité et une chimiothérapie par 5 fluorouracil/mitomycine-C
Purpose: Intensity-modulated radiotherapy (IMRT) has confirmed its superiority in improving acute treatment-related toxicities in anal cancer, without compromising tumor control. However, the impact of IMRT on long-term quality of life(QOL) is poorly documented. The study prospectively evaluated the long-term patient-reported QOL after IMRT based chemoradiation in anal cancer. Methods and Materials: 58 patients treated with IMRT and concurrent 5 fluorouracil/mitomycin-C were enrolled in the study. A pre-specified secondary endpoint was prospective evaluation of long-term QOL. 54 patients underwent QOL evaluation at baseline, after treatment, and during follow-up until 60 months, with EORTC core (QLQ-C30) and colorectal (QLQ-CR29) questionnaires. The QOL scores at baseline and post-treatment periods were compared. Results: QLQ-C30: At 60 months, the mean scores of global health status, all functional scales, and all symptoms except diarrhea had improved indicating normalization of QOL. Clinically and statistically significant improvements in the global health status (15.4; p=0.003), role functioning (19.3; p=0.0017), emotional functioning (18.9; p= p=0.008) and social functioning (29.8; p=<0.001) were observed. Diarrhea persisted as a concern over the years (p=0.172). EORTC QLQ-CR29: Rectal pain (-38.6; p=0.001), mucous or blood discharge per rectum (-22.8; p=0.005) and perianal-soreness (-37.3; p=<0.001) were improved both clinically and statistically. Clinically significant fecal leakage was reported by 16% of patients (5.6; p=0.421). Volumes receiving 45Gy and 54 Gy were independent predictors for fecal incontinence. Clinically and statistically significant urinary incontinence occurred in 21% of patients (17.5; p=0.014). Deterioration of dyspareunia was clinically significant (26.7, p=0.099) at 60 months. Conclusions: When compared with historical data, IMRT is associated with reduced long-term impacts on QOL. The majority of patients treated with IMRT experienced clinically significant recovery of function and improvement in QOL over 5 years after completion of treatment. The study noticed that specific toxicities such as chronic diarrhea, fecal incontinence urinary and sexual dysfunction were primarily responsible for deterioration of the long-term QOL. Future research aimed at reducing such toxicities is needed to further improve long-term QOL in anal cancer.
International Journal of Radiation Oncology, Biology, Physics 2023