Advertisement

Which Side Effects Related to Short-Course Radiotherapy Should Be Described to the Patients Before Treatment?

  • Krzysztof Bujko
Chapter

Abstract

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.

Keywords

Rectal cancer Preoperative short-course radiotherapy 

Notes

Conflict of Interest Statement

Author of this manuscript does not have any conflict of interest.

References

  1. 1.
    Marijnen CA, Kapiteijn E, van de Velde CJ et al (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825CrossRefPubMedGoogle Scholar
  2. 2.
    Marijnen CAM, van de Velde CJ, Putter H et al (2005) Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of multicenter randomized trial. J Clin Oncol 23:1847–1858CrossRefPubMedGoogle Scholar
  3. 3.
    Chen TY, Wiltink LM, Nout RA et al (2015) Bowel function 14 years after preoperative short-course radiotherapy and total mesorectal excision for rectal cancer: report of a multicenter randomized trial. Clin Colorectal Cancer 14:106–114CrossRefPubMedGoogle Scholar
  4. 4.
    Birgisson H, Pahlman L, Gunnarsson U (2005) Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish rectal cancer trial. J Clin Oncol 23:8697–8705CrossRefPubMedGoogle Scholar
  5. 5.
    Pettersson D, Cedermark B, Holm T et al (2010) Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 97:580–587CrossRefPubMedGoogle Scholar
  6. 6.
    Stephens RJ, Thompson LC, Quirke P et al (2010) 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 28:4233–4239CrossRefPubMedGoogle Scholar
  7. 7.
    Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomized trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24CrossRefPubMedGoogle Scholar
  8. 8.
    Tyc-Szczepaniak D, Wyrwicz L, Kepka L et al (2013) Palliative radiotherapy and chemotherapy instead of surgery in symptomatic rectal cancer with synchronous unresectable metastases: a phase II study. Ann Oncol 24:2829–2834CrossRefPubMedGoogle Scholar
  9. 9.
    Radu C, Berglund A, Pahlman L et al (2008) Short course preoperative radiotherapy with delayed surgery in rectal cancer – a retrospective study. Radiother Oncol 87:343–349CrossRefPubMedGoogle Scholar
  10. 10.
    Pettersson D, Glimelius B, Iversen H et al (2013) Impaired postoperative leucocyte counts after preoperative radiotherapy for rectal cancer in the Stockholm III trial. Br J Surg 100:969–975CrossRefPubMedGoogle Scholar
  11. 11.
    Bujko K, Nasierowska-Guttmejer A, Wyrwicz L et al (2013) Neoadjuvant treatment for unresectable rectal cancer: an interim analysis of a multicentre randomized study. Radiother Oncol 107:171–177CrossRefPubMedGoogle Scholar
  12. 12.
    Pietrzak L, Bujko K, Nowacki MP et al (2007) Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol 84:217–225CrossRefPubMedGoogle Scholar
  13. 13.
    Yau I, Vuong T, Garant A et al (2009) Risk of hypogonadism from scatter radiation during pelvic radiation in male patients with rectal cancer. Int J Radiat Oncol Biol Phys 74:1481–1486CrossRefPubMedGoogle Scholar
  14. 14.
    Wiltink LM, Nout RA, Fiocco M et al (2015) No increased risk of second cancer after radiotherapy in patients treated for rectal or endometrial cancer in the randomized TME, PORTEC-1, and PORTEC-2 trials. J Clin Oncol 33:1640–1646CrossRefPubMedGoogle Scholar
  15. 15.
    Birgisson H, Påhlman L, Gunnarsson U, Glimelius B (2005) Occurrence of second cancers in patients treated with radiotherapy for rectal cancer. J Clin Oncol 23:6126–6131CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  1. 1.Department of RadiotherapyThe Maria Sklodowska-Curie Memorial Cancer CentreWarsawPoland

Personalised recommendations