# Patient-Reported Functional Outcomes and Quality of Life After Contact X-Ray Brachytherapy (CXB) in Organ-Preserving Management of Rectal Cancer

## TL;DR

This study shows that contact X-ray brachytherapy combined with (chemo)radiation maintains stable quality of life in rectal cancer patients over one year.

## Contribution

The study provides new data on health-related quality of life outcomes after contact X-ray brachytherapy in rectal cancer treatment.

## Key findings

- Symptom and functional scores remained stable throughout the one-year follow-up.
- Significant improvements were observed in abdominal pain, flatulence, urinary frequency, and body weight at 12 months.
- EQ-VAS scores showed improvement, indicating a good overall quality of life following CXB treatment.

## Abstract

Contact X-ray brachytherapy (CXB) in combination with (chemo)radiation is used as an organ-preserving treatment in rectal cancer management. However, data on health-related quality of life (HRQOL) outcomes after CXB remain limited. This prospective observational study assessed HRQOL after CXB with a one-year follow-up. CXB combined with (chemo)radiation maintained stable HRQOL with some improvements. These findings suggest that CXB treatment, when combined with (chemo)radiation, does not compromise HRQOL of patients and helps them consider the pros and cons of CXB as a treatment option.

Background/Objectives: With recent advancements in rectal cancer management leading to longer patient survival, the impact of various treatment approaches on patients’ quality of life (QOL) becomes an important focus of attention. While QOL studies exist for watch-and-wait after (chemo)radiation with/without local excision, data on health-related QOL (HRQOL) outcomes after contact X-ray brachytherapy (CXB) remain limited. This study evaluated functional and HRQOL outcomes in rectal cancer patients undergoing CXB and (chemo)radiation over one year. Methods: This prospective observational study (enrolment January–October 2023) with one-year follow-up assessed functional and HRQOL outcomes after CXB and (chemo)radiation using EORTC-QLQ-CR29, HADS, and EQ-5D-3L questionnaires. Longitudinal analyses were conducted using linear mixed-effects models, incorporating both fixed and random effects, following data processing based on relevant scoring manuals. Results: QOL was assessed in 53 patients who attended our centre for CXB for various clinical indications, with 51, 47, and 42 remaining at the end of treatment, 6-month, and 12-month follow-ups, respectively. Overall, symptom and functional scores from EORTC-QLQ-CR29 remained stable throughout the follow-up period. Significant improvements were observed in abdominal pain, flatulence, urinary frequency, and body weight at 12 months. HADS and EQ-5D-3L scores remained stable, while EQ-VAS scores showed improvement, indicating a good overall quality of life following CXB treatment. Conclusions: CXB treatment combined with (chemo)radiation maintained stable HRQOL, with some improvements in symptoms and QOL noted during the subsequent year. These findings will help rectal cancer patients understand the benefits and limitations of CXB as a treatment option.