For most patients with rectal cancer treatment consists of surgical resection of the rectum, which is preceded by (chemo) radiotherapy depending on the disease stage. On the short and long term, this treatment can have a negative effect on the quality of life of patients. Rectum-sparing techniques, i.e. a local excision or an active surveillance strategy without surgery in patients with a complete response to (chemo) radiotherapy, may have better effects of patients’ quality of life.
The first part of this thesis describes the effects of the operative treatment for rectal cancer on patient-reported outcomes such as functioning, symptoms and work ability during the first 2 years after diagnosis. Different radiotherapy schedules and surgical procedures are compared. Also, the difference in quality of life between older and younger patients with rectal cancer is investigated. Furthermore, preferences of patients and volunteers (without rectal cancer) for different treatment scenarios for rectal cancer are discussed.
The second part of this thesis focuses on the role of radiotherapy. The chapters mainly focus on how this treatment can be optimized to make more patients with rectal cancer eligible for rectum-sparing treatment options. The results of a randomized controlled trial are evaluated in which the effect of an additional radiation dose (a boost) to the tumour prior to chemoradiotherapy on a complete tumour response is investigated.