More Factors Should Have Been Considered
The authors are to be thanked for dealing with this important topic, for having conducted their study in such a large cohort of patients, and for publishing the results.
In analyzing how multimodal therapies affect the quality of life of patients with rectal cancers, further factors should be investigated in addition to age and sex, so as to obtain as complete a picture as is possible of the harm patterns and their mechanisms. The authors reported that 48% of the 368 patients had received adjuvant radiotherapy. In addition to surgery related morbidity, irradiation of the pelvis can lead to significantly deteriorated anal sphincter function (1) and sexual function (2). In male patients, the testes are affected by scattered radiation, which in turn may harm the Leydig cells and result in chronically subnormal testosterone concentrations (3). This should be borne in mind when investigating or treating posttherapeutic fatigue. Consequently, (neo)adjuvant therapeutic modalities should be described as comprehensively as possible in such studies.
PD Dr. med. Robert M. Hermann
Zentrum für Strahlentherapie und Radioonkologie
Ärztehaus an der Ammerlandklinik
26655 Westerstede, Germany
|1.||Peeters KC, van de Velde CJ, Leer JW: Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J Clin Oncol 2005; 23: 6199–206. MEDLINE|
|2.||Marijnen CA, van de Velde C, Putter H, et al.: Impact of short-term preoperative radiotherapy on health-related quality of life and sexualfunctioning in primary rectal cancer: Report of a multicenter randomized trial. J Clin Oncol 2005; 23(9): 1847–58. MEDLINE|
|3.||Hermann RM, Henkel K, Christiansen H, et al.: Testicular dose and hormonal changes after radiotherapy of rectal cancer. Radiother Oncol 2005; 75: 83–8. MEDLINE|
|4.||Schmidt C, Daun A, Malchow B, Küchler T: Sexual impairment and its effects on quality of life in patients with rectal cancer [Einschränkungen der Sexualität und ihr Einfluss auf die Lebensqualität bei Patienten mit Rektumkarzinom]. Dtsch Arztebl Int 2010; 107(8): 123–30. VOLLTEXT|