放疗可减少局部晚期直肠癌的局部复发，但可能对未复发的患者造成伤害。目的是调查放疗对直肠癌根治性治疗后（即随访期间未复发的患者）长期生活质量的影响。挪威所有 75 岁以下的直肠癌患者均在2007年9月30日和2020年10月1日是通过挪威癌症登记处确定的。排除标准为远处转移、复发和痴呆。主要结果指标是胃肠生活质量指数。次要成果衡量标准包括 36 项简短调查。在评估结果差异时，使用基于多元逻辑回归模型的逆概率权重来平衡放疗组和无放疗组之间的预选协变量。在 5014 名受邀患者中，2142 名（43%）符合条件的患者回答了问卷。其中 762 例 (36%) 接受新辅助放疗加手术治疗，1380 例 (64%) 接受单纯手术治疗。平均随访时间分别为 6.4 年和 7.4 年。倾向评分匹配后，接受照射和未接受照射的患者的胃肠生活质量指数存在显着差异（（平均值（s.d.），平均分分别为 103.8（19.4）与 110.8（19.6），平均差：-6.96（95% c.i. - 8.72 至 -5.19）；在没有造口的患者中，平均差异为 -8.1 分，而在 8 个 36 项短项目中，放疗组的平均差异为 -5.7 分。与单独手术组相比，表格调查领域。与未接受放疗的患者相比，在随访期间没有复发的患者的长期生活质量显着降低。这些发现需要对放疗的使用进行严格的重新评估。放疗在传统新辅助治疗和现代器官保留治疗方案中的应用。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up.All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes.Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: -6.96 (95% c.i. -8.72 to -5.19); P < 0.001). Among patients without a stoma the mean difference was -8.1 points, whereas it was -5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group.Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.