gms | German Medical Science

Purpose: The purpose of this study was collecting data from irradiated patients with rectal cancer concerning acute and late toxicity and exploring possible implications of epidemiological factors.

Methods: Acute toxicity was prospectively documented with CTC scores. Late toxicity was registered by a patient questionnaire based on LENT SOMA classification.

Results: From 1997 to 2003 152 patients with rectal cancer were treated at Alfried Krupp Hospital. 117 with adjuvant, 17 with neoadjuvant and 18 with definitive radiotherapy. Chemotherapy was administered in 91%. Severe side effects (CTC>2°) were mostly gastrointestinal (18%), followed by haematological complications and skin toxicity (each 5%) and urogenital toxicity (2%). Gastrointestinal side effects were associated with operation method (p<0,05) and with the dose volume histogram (p<0,05). The chemotherapy protocol correlated with haematological toxicity (p<0.01). The given total dose (p<0.05) and the location of tumour (p<0.05) were factors for skin reaction. The follow up of 102 patients from 104 living patients was possible. 65% had gastrointestinal symptoms, 40% reported urogenital side effects, 30% had skin alterations. 68% suffered from stool incontinence, 19% urinal incontinence. 85% of male patients reported erectile dysfunction. Tumour location, total dose of radiotherapy and operation method had a significant impact also for late toxicity. Life quality was measured by a VAS. Gastrointestinal late effects had a negative influence on life quality, anus praeternaturalis had no impact.

Conclusions: Consequent documentation of CTC scores allows a differentiated analysis of acute toxicity. A standard LENT SOMA questionnaire improves quality of follow up. There is no significant correlation between acute and late side effects. Life quality is mainly affected by intestinal toxicity.