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Observational Study
. 2025 Jul;27(7):e70158.
doi: 10.1111/codi.70158.

Impact of preoperative radiotherapy on patient-reported outcomes in rectal cancer

Robert Siegel  1 , Nora Tabea Sibert  2   3 , Clara Breidenbach  2 , Cihan Gani  4 , Philipp Alexander Neumann  5 , Stefan Rolf Benz  6 , Stefan Post  7 , Thomas Seufferlein  8 , Vanessa Kolb  9 , Matthias Behrend  10 , Richard David Blossey  11 , Jörg Bunse  12 , Marc Dahlke  13 , Ricarda Diller  14 , Nikos Emmanouilidis  15 , Thomas J Ettrich  8 , Jörg Fahlke  16 , Sven Flemming  17 , Björn Freitag  18 , Martin Fuchs  19 , Lars Haeder  20 , Stephan Hollerbach  21 , Jens Höppner  22 , Mia Kim  23 , Christian Klink  24 , Jürgen Knuth  25 , Stefan Koeppen  26 , Jörg Köninger  27 , Ernst Wolfgang Kolbe  28 , Florian Kühn  29 , Shueb Mussa  30 , Robert Oehring  31   32 , Sebastian Petzoldt  33 , Pompiliu Piso  34 , Christian Prause  35 , Christian Prinz  36 , Christoph Reißfelder  37 , Maren Riechmann  38 , Jörg-Peter Ritz  39 , Jens Rolinger  40 , Robert Rosenberg  41 , Hubert Scheuerlein  42 , Dustin Schilawa  43 , Paul Magnus Schneider  44 , Thilo Schwandner  45 , Marco Siech  46 , Daniel Steinemann  47 , Oliver Stöltzing  48 , Elke von Haeften  49 , Dominik Weihs  50 , Armin Wiegering  51 , Christina Barbara Zielinski  52 , Christoph Kowalski  2
Affiliations
Observational Study

Impact of preoperative radiotherapy on patient-reported outcomes in rectal cancer

Robert Siegel et al. Colorectal Dis. 2025 Jul.

Abstract

Aim: To prospectively evaluate the effect of preoperative radiotherapy followed by surgery versus surgery alone on patient-reported outcomes (PROs) 1 year after surgery.

Method: Prospective observational cohort study in 127 colorectal cancer centres. Patients with rectal cancer completed European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core (EORTC-QLQ-C30) and Colorectal module (-CR29) questionnaires (thus providing PROs) before initialization of treatment [baseline (T0)] and at 12 months after surgery [follow up (T1)]. The PRO data together with sociodemographic information were linked to clinical data. Relevant confounders were identified using directed acyclic graphs. The effect of preoperative radiotherapy on selected PROs 12 months after surgery was estimated using adjusted tobit regression models.

Results: Of 1635 patients with rectal cancer for whom both baseline and follow-up PROs were available, 565 (35%) received preoperative radiotherapy. Twelve months after surgery, patients with surgery alone reported better scores for global health status/Quality of Life, urinary incontinence, faecal incontinence (patients without stoma), dyspareunia (female patients) and impotence (male patients) than did patients receiving preoperative radiotherapy. The statistically significant effects ranged between 33.20 (p < 0.001, R2 = 0.19) for impotence and 39.01 (p = 0.001, R2 = 0.10) for dyspareunia. For global health status/QoL and urinary incontinence, no statistically significant effect could be found.

Conclusion: Radiotherapy in addition to surgery negatively affects selected PROs 1 year after surgery in patients with rectal cancer. Compared with surgery alone, patients report profoundly impaired bowel and sexual function after preoperative radiotherapy. However, global health status/QoL was not affected statistically significantly. These results are an important argument for limiting preoperative radiotherapy to patients with a high risk of recurrence of rectal cancer and may facilitate informed decision-making.

Trial registration: German Clinical Trial Registry Number DRKS00008724 (https://drks.de/search/de/trial/DRKS00008724).

Keywords: chemoradiotherapy; patient‐reported outcome (PRO); quality of life (QoL); radiotherapy; rectal cancer; surgery.

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References

REFERENCES

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