Original Research Article
Year: 2021 | Month: February | Volume: 8 | Issue: 2 | Pages: 380-388
DOI: https://doi.org/10.52403/ijrr.20210251
Role of Palliative Surgery and Whole Pelvic Radiotherapy on Symptom Palliation and Quality of Life in Advanced Rectal Cancer: a Prospective Observational Study
Sourav Sau1, Saikat Sau2, Abhishek Basu1
1Assistant Professor, Department of Radiotherapy, Burdwan Medical College & Hospital, Purba Bardhaman
2Associate Professor, Department of Cardiology, Bankura Sammilani Medical College & Hospital, Bankura
Corresponding Author: Abhishek Basu
ABSTRACT
Introduction: Patients with metastatic / advanced inoperable rectal cancer usually complain of symptoms like per rectal bleeding, local pain and irregular bowel habits. The main objective of care in these patients is to improve overall survival (OS) while palliating the symptoms and maintaining the Health Related Quality of Life (HRQoL). This may be achieved by either palliative surgery or radiotherapy along with systemic chemotherapy and we aimed to investigate these two modalities for symptom palliation, HRQoL and OS.
Material and methods: The advanced rectal cancer (AJCC Stage group IV) patients with pelvic symptoms (rectal bleeding, pain or obstructive features) aged 18 – 75 years with ECOG PS 0 – 3 were included in this prospective non randomized observational study. Choice of palliative surgery or radiotherapy was done by MDT discussion. Symptoms and HRQoL (using FACT-G) were assessed at baseline, after intervention and every three months thereafter till one year.
Results: Between February 2017 to June 2020, 102 patients of advanced rectal cancer were accrued. Eighty six patients were ultimately evaluated. Change in bowel habit (76%), pain (62%) rectal bleeding (37%) were the most common symptoms. Sixty seven patients received pelvic radiotherapy and nineteen underwent palliative surgery. Overall response rate at 3rd month after completion of treatment was 59%. Symptom control rates and time to symptom progression were comparable. The mean score of HRQoL were higher in the Radiotherapy arm. There were no grade III-IV toxicity. Median OS was eight and ten months in the surgery and radiotherapy arms, respectively.
Conclusion: Morbid surgical procedure renders no advantage over palliative radiotherapy in metastatic rectal cancer with respect to palliation of pelvic symptoms and maintenance of HRQoL.
Keywords: Rectal cancer, advanced, symptom, palliation, HRQoL.
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