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. Differences between the two groups were compared, and baseline data from the general population who completed the EORTC QLQ-C30 were also compared.
Results: The median follow-up was 77.38 (59.07-103.20) months, with 196 out of 414 surviving patients (47.3%) completing the questionnaire. Patients in the TNT group had better emotional function (94.16±10.19 vs. 90.17±14.63, P=0.031) but more severe diarrhea (12.46±21.73 vs. 6.74±16.03, P=0.036) than did those in the CRT group. However, the mean differences between the two groups were less than 5 points, which is not clinically significant, and there were no significant differences in other quality of life items. The Wexner incontinence scores were 5 (0-6) and 3 (0-6) for the TNT and CRT groups, respectively, with no significant difference between the groups (P=0.357). Compared to the general population data from the completed EORTC QLQ-C30 assessment, the patients did not exhibit differences greater than 5 points in terms of worse function or more severe symptoms.
Conclusions: There were no significant differences in quality of life or anal function between patients receiving TNT and those receiving CRT. After 6 years, patients were able to maintain stability.
Keywords: Anal function; Quality of life; Total neoadjuvant therapy.
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