Quality of life Long-term quality-of-life after neoadjuvant short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer Matthias Guckenberger a,⇑ , Gabriella Saur a , Daniel Wehner a , Andreas Thalheimer b , Mia Kim b , Christoph-Thomas Germer b , Michael Flentje a a Department of Radiation Oncology; b Department of Surgery I, University of Wuerzburg, Germany article info Article history: Received 5 March 2012 Received in revised form 18 June 2013 Accepted 12 August 2013 Available online 7 September 2013 Keywords: Rectal cancer Quality-of-life Short course radiotherapy Long course radiochemotherapy Neoadjuvant abstract Purpose: To evaluate long-term quality-of-life (QoL) after neoadjuvant short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer. Methods: Between 1999 and 2008, 225 patients were treated with curative intent for locally advanced rectal cancer using neoadjuvant SC-RT (n = 108) or LC-RCHT (n = 117). SC-RT delivered 10 Â 2.9 Gy twice daily with immediate surgery. LC-RCHT delivered 28 Â 1.8 Gy concomitant with 5-FU based chemother- apy and delayed surgery. A cross-sectional QoL analysis was performed in disease-free patients using the EORTC-QLQ-C30 and EORTC-QLQ-CR29 questionnaires. Results: After a median follow-up of 67 months, 133 patients were disease-free of which 120 (90%) returned the QoL questionnaires. Patients in the LC-RCHT cohort had a higher rate of uT4, uN+ and low tumor location. No difference in QoL was observed between SC-RT and LC-RCHT except an improved physical functioning in the LC-RCHT group (p = 0.04). Comparing our total patient cohort with the general German population showed no difference in global health status but decreased QoL in several functional and bowel symptom scores. Conclusions: The finding of comparable long-term QoL after SC-RT and LC-RCHT adds to our knowledge of equivalent oncological outcome and may be useful in the decision making process between the two neo- adjuvant approaches. Ó 2013 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 108 (2013) 326–330 In locally advanced or node positive rectal cancer, multimodality treatment including surgery and radiotherapy is the current stan- dard of care. Two approaches of multimodality treatment have been validated in large randomized phase III trials: either neoadjuvant short-course radiotherapy (SC-RT) within one week and immediate surgery or neoadjuvant 5-FU based long-course radiochemotherapy (LC-RCHT) over 4–5 weeks with delayed surgery. Short course radiotherapy improves overall survival (OS) when added to non- TME surgery [1] and improves local control (LC) when added to TME surgery with a potential overall survival benefit for stage III rectal cancer [2]. Long-course radiochemotherapy improves local control when compared to adjuvant radiochemotherapy [3]. Sphincter-preservation in patients with low tumor location and downstaging when the circumferential margin is at risk are poten- tial advantages of LC-RCHT over SC-RT. However, randomized trials comparing SC-RT with LC-RCHT did not find significant differences in any oncological endpoint except increased acute toxicity associated with LC-RCHT [4,5]. Overall quality-of-life (QoL) after curative treatment for rectal cancer is considered to be good [6], however, both surgery and radiotherapy affect particularly short-term and long-term sexual and anorectal function [7–9]. One concern about SC-RT is the use of hypo-fractionated large single fraction doses compared to LC- RCHT, which might increase long-term toxicity and decrease QoL, despite adjustment of total physical dose. In this study, we per- formed a cross-sectional analysis of long-term QoL after SC-RT and LC-RCHT and compared QoL to the general German population. Patients and methods Between 1999 and 2008, 225 patients were treated with cura- tive intent for pathologically proven locally advanced rectal cancer using neoadjuvant SC-RT (n = 108) or LC-RCHT (n = 117) at the Department of Radiation Oncology, University Hospital Wuerz- burg. A cross-sectional QoL analysis was performed in 2011; only patients free-of disease were contacted (n = 133; SC-RT n = 62 and LC-RCHT n = 71). Detailed patient and treatment characteris- tics are described in Table 1. Between 2001 and 2004, patients were treated within a pro- spective phase II trial using SC-RT. LC-RCHT was practiced only 0167-8140/$ - see front matter Ó 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.radonc.2013.08.022 ⇑ Corresponding author. Address: Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider Str 11, 97080 Wuerzburg, Germany. E-mail address: Guckenberger_M@klinik.uni-wuerzburg.de (M. Guckenberger). Radiotherapy and Oncology 108 (2013) 326–330 Contents lists available at ScienceDirect Radiotherapy and Oncology journal homepage: www.thegreenjournal.com