Short-course radiotherapy (5 × 5 Gy) in rectal cancer is routinely being used preoperatively, either immediately before surgery or with surgery performed 6–8 weeks later. Acute toxicity, mostly grade I, occurred over the period of 5 × 5 Gy deliveries in about 25% of the patients, grade III complications in 0–3%. Most of the post-radiation toxicity occurs 3–7 days after the completion of radiotherapy in 27–41% of the patients; grade III side effects occurred in 2% to 5% of the patients. 5 × 5 Gy given immediately before surgery cases slightly increase in minor postoperative complications compared with surgery alone or when surgery is delayed after 5 × 5 Gy. Short-course preoperative radiotherapy causes several chronic functional problems. However, these problems do not seriously affect quality of life. Preoperative 5 × 5 Gy radiotherapy enhances severity of low anterior resection syndrome; after median 14.6 years of follow-up, major syndrome was observed in 56% of patients in the 5 × 5 Gy plus surgery group compared to 35% in the surgery only group, P < 0.01. In young women, 5 × 5 Gy to the pelvis results in radiation-induced menopause and infertility. Preoperative radiotherapy was associated with reduced vaginal dimensions, vaginal dryness, dyspareunia and lack of desire. Preoperative 5 × 5 Gy radiotherapy increases males sexual dysfunctions (ejaculation disorders and erectile functioning) caused by surgery. Scatter radiation dose at the testicles may result in a permanent infertility and in a risk of hypogonadism.
Rectal cancer Preoperative short-course radiotherapy
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Conflict of Interest Statement
Author of this manuscript does not have any conflict of interest.
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