Quality of life after non-surgical treatment of anal carcinoma: a case control study of long-term survivors.

AIMS: To evaluate the quality of life (QOL) of a cohort of patients after non-surgical treatment of anal carcinoma with chemotherapy and radiation. MATERIALS AND METHODS: Patients treated for anal carcinoma at the British Columbia Cancer Agency between 1990 and 2001 were identified from audit data. A total of 92 suitable patients were found among these. They were approached by letter and encouraged to complete questionnaires regarding their QOL. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-CR38 instruments were used to evaluate general QOL, and more disease and site-related aspects. Fifty responses were received and were compared with those of a sample of matched local volunteer control participants who had not received any treatment to their abdomen or pelvis. Responses were scored and the results analysed with the SPSS statistical package. RESULTS: Significant differences were detected in global QOL and in more specific areas of both general and site/disease-specific nature. Identified general areas involved physical, social, and role functions, and symptoms of fatigue, nausea and vomiting, dyspnoea, appetite loss, diarrhoea, constipation, and financial problems, with cancer/site-related micturition, gastrointestinal and chemotherapy side-effect symptoms, and male and female sexual problems. CONCLUSION: This study reveals that after curative treatment for anal carcinoma with chemoradiation that has spared the patient of surgery, issues affecting QOL can present in a significant proportion of patients.

Radiotherapy for craniopharyngioma in children: a national audit.

A survey of current radiotherapy practices in the United Kingdom for treatment of craniopharyngioma in children was undertaken in view of the need to optimize control and minimize side effects in a patient group who can expect to survive for prolonged periods after treatment. Useable replies were received from 16 practitioners. A high level of conformity was reported in some areas but practice varied considerably in others. Thus whereas 15 employed magnetic resonance imaging (MRI) alone or with computed tomography (CT) to establish the gross tumour volume (GTV), six exclusively used pre-operative and seven exclusively used post-operative studies. Twelve added a margin of 1 cm to establish the planning target volume (PTV). Nine used CT planning. Fourteen gave radiation doses of between 50 and 55 Gy, but eight different dose/fractionation combinations were used. The most favoured regime (used by six) was 50 Gy in 30 fractions. Two centres provided written information on possible side effects of treatment. We suggest that it might prove helpful if a national treatment protocol was developed.

Radiation-induced haemorrhagic cystitis.

OBJECTIVES: In this article we review the literature concerning the frequency and management of severe haemorrhagic radiation-induced cystitis. METHODS: A Medline search was performed from 1966 to 1999 for articles in English. A total of 309 references were found. Abstracts and complete articles were reviewed. RESULTS: Severe haemorrhagic cystitis following radiotherapy remains a relatively rare event. However, the fact that it is relentlessly progressive and that treatment options are suboptimal makes it clinically important. The incidence of severe haematuria following pelvic irradiation is difficult to determine from the literature although most studies state an incidence of less than 5% which increases with time since irradiation. Methods of treatment include simple bladder irrigation, cystodiathermy, oral, parenteral and intravesical agent, hyperbaric oxygen therapy, hydrodistension, internal iliac embolisation, urinary diversion and cystectomy. No management strategy is 100% successful and a stepwise progression in treatment intensity is often required. CONCLUSION: The articles available on radiation-induced haemorrhagic cystitis are principally retrospective and involve small numbers of patients who have had several different treatment modalities. In the absence of randomised studies comparing treatments, it is impossible to set definitive rules about management but patients with this condition probably warrant early and aggressive treatment.