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Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study

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Abstract

Background

The objective of the study is to determine the correlations among the variables of dose and the sphincter function (SF) in patients with locally advanced rectal cancer treated with preoperative capecitabine/radiotherapy followed by low anterior resection (LAR) + TME.

Methods

We retrospectively reviewed 92 consecutive patients with LARC treated at our center with LAR from 2006 and more than 2 years free from disease. We re-contoured the anal sphincters (AS) of patients with the help of the radiologist. SF was assessed with the Wexner scale (0–20 points, being punctuation inversely proportional to annal sphincter functionality). All questionnaires were filled out between January 2010 and December 2012. Dosimetric parameters that have been studied include V 20, V 30, V 40, V 50, mean dose (D mean), minimum dose (D min), D 90 (dose received by 90% of the sphincter) and D 98.

Statistical analysis

The correlations among the variables of dose and SF were studied by the Spearman correlation coefficient. Differences in SF relating to maximum doses to the sphincter were assessed by the Mann–Whitney test.

Results

Mean Wexner score was 5.5 points higher in those patients with V 20 > 0 compared to those for which V 20 = 0 (p = 0.008). In a multivariate regression model, results suggest that the effect of V 20 on poor anal sphincter control is independent of the effect of distance, with an adjusted OR of 3.42.

Conclusions

In order to improve the SF in rectal cancer treated with preoperative radiotherapy/capecitabine followed by conservative surgery, the maximum radiation dose to the AS should be limited, when possible, to <20 Gy.

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References

  1. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016. http://www.cdc.gov/uscs.

  2. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  CAS  Google Scholar 

  3. Wong RKS, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochr Datab Syst Rev. 2007, Issue 2. Art. No.: CD002102. doi:10.1002/14651858.CD002102.pub2.

  4. Cedermark B, Johansson H, Rutqvist LE, Wilking N. The Stockholm I Trial of preoperative short term radiotherapy in operable rectal carcinoma. Cancer. 1995;75:2269–75.

    Article  CAS  Google Scholar 

  5. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):690–2.

    Article  Google Scholar 

  6. Stockholm Colorectal Cancer Study Group & Cedermark. B. Ann Surg Oncol. 1996;3:423.

    Article  Google Scholar 

  7. Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005;23:5644–50.

    Article  Google Scholar 

  8. Marijnen CAM, van de Velde CJH, Putter H, van den Brink M, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23:1847–58.

    Article  Google Scholar 

  9. Stephens RJ, Thompson LC, Quirke P, Steele R, Grieve R, Couture J, et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients’ quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J Clin Oncol. 2010;28:4233–9.

    Article  Google Scholar 

  10. Yen-TingChen T, Emmertsen KJ, Laurberg S. What are the best questionnaires to capture anorectal function after surgery in rectal cancer? Curr Colorectal Cancer Rep. 2015;11:37–43.

    Article  Google Scholar 

  11. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.

    Article  CAS  Google Scholar 

  12. Jorge JMN, Wexner SD. Etiology and management of fecal incontinence. Dis Colon Rectum. 1993;36:77–97.

    Article  CAS  Google Scholar 

  13. Alsadius D, Hedelin M, Lundstedt D, Pettersson N, Wilderäng U, Steineck G. Mean absorbed dose to the anal-sphincter region and fecal leakage among irradiated prostate cancer survivors. Int J Radiat Oncol Biol Phys. 2012;84:181–5.

    Article  Google Scholar 

  14. Dunberger G, Lind H, Steineck G, Waldenström AC, Nyberg T, Al-Abany M, et al. Self-reported symptoms of faecal incontinence among long-term gynaecological cancer survivors and population-based controls. Eur J Cancer. 2010;46(3):606–15.

    Article  Google Scholar 

  15. Maeda Y, Parés D, Norton C, Vaizey CJ, Kamm MA. Does the St. Mark’s incontinence score reflect patients’ perceptions? A review of 390 patients. Dis Colon Rectum. 2008;51:436–42.

    Article  Google Scholar 

  16. Alburquerque A. Endoanal ultrasonography in fecal incontinence: current and future perspectives. World J Gastrointest Endosc. 2015;7:575–81.

    Article  Google Scholar 

  17. Parangama C, Anu E, Sukria N. Endoanal ultrasound assessment of sphincter defects and thinning—correlation with anal manometry. Arab J Gastroenterol. 2014;15(1):27–31.

    Article  Google Scholar 

  18. Kadoya N. Use of deformable image registration for radiotherapy applications. J Radiol Radiat Ther. 2014;2:1042.

    Google Scholar 

  19. Emmertsen KJ, Laurberg S, Rectal Cancer Function Study Group. Impact of bowel dysfunction on quality of life after sphincter-preserving resection for rectal cancer. Br J Surg. 2013;100(10):1377–87.

    Article  CAS  Google Scholar 

  20. Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Quality of life in rectal cancer patients. A four-year prospective study. Ann Surg. 2003;238(2):203–13.

    PubMed  PubMed Central  Google Scholar 

  21. Schaake W, van der Schaaf A, van Dijk L, Bongaerts A, van den Bergh A, Langendijk J. Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients. Radiother and Oncol. 2016;119:381–7.

    Article  Google Scholar 

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Acknowledgements

This work has been done thanks to a grant from the “Mutua Madrileña Foundation”. All patients signed the informed consent before entering the study.

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Authors and Affiliations

  1. Radiation Oncology Department, Complejo Hospitalario de Navarra, Irunlarrea 3, Pamplona, 31008, Spain

    F. Arias, C. Eito, G. Asín, I. Mora, M. Barrado, M. Campo & I. Visus

  2. Department of Statistics, Complejo Hospitalario de Navarra, Pamplona, Spain

    K. Cambra & B. Ibáñez

  3. Department of Physics, Complejo Hospitalario de Navarra, Pamplona, Spain

    F. Mañeru

  4. Radiation Oncology Department, Clinica Universitaria de Navarra, Pamplona, Spain

    L. Arbea, J. I. Arrarás, M. Errasti & S. Flamarique

  5. Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain

    A. Viudez & I. Hernández

  6. Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain

    M. A. Ciga

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  1. F. Arias
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  2. C. Eito
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  3. G. Asín
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  14. M. Campo
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  15. I. Visus
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Corresponding author

Correspondence to F. Arias.

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Arias, F., Eito, C., Asín, G. et al. Fecal incontinence and radiation dose on anal sphincter in patients with locally advanced rectal cancer (LARC) treated with preoperative chemoradiotherapy: a retrospective, single-institutional study. Clin Transl Oncol 19, 969–975 (2017). https://doi.org/10.1007/s12094-017-1627-0

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  • DOI: https://doi.org/10.1007/s12094-017-1627-0

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