Gemellus

Abstract

At last a paper from Amsterdam and Maastricht by those reliable Dutch on the impact of radiotherapy on anorectal function in patients with rectal cancer (Radiotherapy and Oncology 2019; 132: 79–84). Thirty-three patients with primary rectal cancer who were treated with chemoradiotherapy and a watchand-wait policy with minimum follow-up of 2 years were included. Anorectal function was assessed using anorectal manometry and patient reported outcomes [Vaizey and low anterior resection syndrome (LARS) scores]. Dose-volume histograms were calculated for the rectum and anal sphincter complex, and associations between the dose-volume parameters and anorectal function were assessed. The mean dose of radiotherapy to the rectum and anal sphincter complex was 50.5 and 44.7 Gy, respectively. After a median follow-up of 38 (range 23–116) months, 33.3% of the patients reported major LARS with the mean score of 23.4 11.3 and the mean Vaizey score of 4.3 4.1. The most frequent complaints were clustering of defecation and faecal urgency. Trends towards a higher Vaizey and LARS score after higher anal sphincter complex doses were observed, although these associations were not statistically significant. Gemellus applauds the report as it is the first study to investigate the late dose-volume effects of radiotherapy specifically on the anorectal function in rectal cancer patients. One-third of the patients had major LARS, and the most frequent reported complaints were clustering and faecal urgency. Additionally, the authors observed trends towards worse longterm anorectal function after higher anal sphincter complex radiotherapy doses.