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Quality of life and functional outcomes in patients with locally advanced rectal cancer receiving total neoadjuvant therapy versus concurrent chemoradiotherapy: An analysis of the XXX trial.

Int J Radiat Oncol Biol Phys

January 2025

State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China; Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Shenzhen, China. Electronic address:

Objective: To explore differences in the effects of total neoadjuvant therapy (TNT) and preoperative concurrent chemoradiotherapy (CRT) on quality of life and functional outcomes in patients with locally advanced rectal cancer.

Methods: In the study, 591 patients with distal or middle-third, clinical primary tumor stage cT3-4 and/or regional lymph node-positive rectal cancer were randomly assigned (1:1) to receive short-term radiotherapy (25 Gy in five fractions) followed by 4 cycles of CAPOX (TNT group, n=297) or standard concurrent chemoradiotherapy (50 Gy in 25 fractions concurrently with oral capecitabine) (CRT group, n=294) before surgery. After a 6-year follow-up, the surviving patients were sent surveys, including the EORTC QLQ-C30, EORTC QLQ-CR29, and Wexner incontinence score questionnaires.

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Background: Radiation-induced late fecal incontinence (LFI) is one of the most quality-of-life impairing symptoms in prostate cancer. We aimed to assess the impact of radiotherapy (RT) technique and dose-volume effects on LFI using a robust score.

Methods: We identified 409 patients who underwent curative intent using standard fractionated radiation therapy, 190 of them were finally included and analyzed.

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Limb disorders and slurred speech are common clinical symptoms associated with acute ischemic stroke. Although urinary incontinence is a known symptom in many cases of acute ischemic stroke, the simultaneous impairment of both bowel and bladder function is relatively rare. The occurrence of fecal and urinary incontinence as the primary clinical manifestation in minor acute ischemic stroke is especially uncommon.

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Bile acid diarrhea (BAD) is a chronic and socially debilitating disease characterized by abdominal pain, diarrhea, urgency, and fecal incontinence. Recently, in a six-week randomized controlled trial (RCT), we showed that the glucagon-like peptide 1 receptor agonist (GLP-1RA) liraglutide is superior to bile acid sequestration (considered standard-of-care) using colesevelam in reducing BAD symptoms. The emergence of new, more potent, and longer-acting GLP-1RAs has spurred an interest in these treatments in BAD management.

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Purpose: Low anterior resection (LAR) is the preferred surgical treatment of rectosigmoid or rectal cancers. However, it is often associated with bowel dysfunction, which is termed low anterior resection syndrome (LARS). Daily bowel dysfunction symptoms have a detrimental effect on quality of life (QOL).

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