Urologic and sexual morbidity following multimodality treatment for locally advanced primary and locally recurrent rectal cancer

Aims: In the treatment of patients with locally advanced primary or locally recurrent rectal cancer much attention is given to the oncological aspects . In long-term survivors, urogenital morbidity can have a large effect on t he quality of life. This study evaluates the functional outcome after multi modality treatment in these patient groups. Patients and methods: Between 1994 and August 1999, 55 patients with locall y advanced primary and 66 patients with locally recurrent rectal cancer wer e treated with multimodality treatment: i.e. high-dose preoperative externa l beam radiation therapy, followed by extended surgery and intraoperative r adiotherapy. The medical records of the 121 patients were reviewed. To asse ss long-term urogenital morbidity, all patients still alive, with a minimum followup of 4 months, were asked to fill out a questionnaire about their v oiding and sexual function. Seventy-six of the 79 currently living patients (96%) returned the questionnaire (median FU 14 months, range 4-60). Results: The questionnaire revealed identifiable voiding dysfunction as a n ew problem in 31% of the male and 58% of the female patients. In 42% of pat ients after locally advanced primary and 48% after locally recurrent rectal cancer treatment bladder dysfunction occurred. The preoperative ability to have an orgasm had disappeared in 50% of the male and 50% of the female pa tients, and in 45% of patients after locally advanced primary and in 57% af ter locally recurrent rectal cancer treatment. Conclusion: Multimodality treatment for locally advanced primary and recurr ent rectal cancer results in acceptable urogenital dysfunction if weighed b y the risk of uncontrolled tumour progression. Long-term voiding and sexual function is decreased in half of the patients. Preoperative counselling of these patients on treatment-related urogenital morbidity is important. (C) 2001 Harcourt Publishers Ltd.