Quality of Life and Functional Outcomes in Patients With Locally Advanced Rectal Cancer Receiving Total Neoadjuvant Therapy Versus Concurrent Chemoradiation Therapy: An Analysis of the STELLAR Trial

作者：Huiying Ma, Haoyue Li, Tongzhen Xu, Jinming Shi, Jiacheng Shuai, Shixin Liu, Wenling Wang, Yuan Zhu, Lichun Wei, Yong Cai, Guanghui Cheng, Shulian Wang, Ye‐Xiong Li, Yuan Tang, Jing Jin · 发表于：International Journal of Radiation Oncology*Biology*Physics · 年份：2025 · DOI：10.1016/j.ijrobp.2024.12.035 · 被引用次数：7 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Endometrial and Cervical Cancer Treatments

PURPOSE: To explore differences in the effects of total neoadjuvant therapy (TNT) and preoperative concurrent chemoradiation therapy (CRT) on quality of life and functional outcomes in patients with locally advanced rectal cancer. METHODS AND MATERIALS: In the study, 591 patients with distal or middle-third, clinical primary tumor stage cT3 to 4 and/or regional lymph node-positive rectal cancer were randomly assigned (1:1) to receive short-term radiation therapy (25 Gy in 5 fractions) followed by 4 cycles of CAPOX (TNT group, n = 297) or standard CRT (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 European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30, EORTC QLQ-CR29, and Wexner incontinence score questionnaires. Differences between the 2 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 = .031) but more severe diarrhea (12.46 ± 21.73 vs 6.74 ± 16.03, P = .036) than did those in the CRT group. However, the mean differences between the 2 groups were <5 points, which is not clinically significant, and t...