Possible Risk Factors Associated with Radiation Proctitis or Radiation Cystitis in Patients with Cervical Carcinoma after Radiotherapy

  • Yang, Lin (Department of Radiation Oncology, the First Affiliated Hospital of Anhui Medical University) ;
  • Lv, Yin (Department of Radiation Oncology, the First Affiliated Hospital of Anhui Medical University)
  • Published : 2012.12.31


Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinoma following radiotherapy. In the present study, we aimed to determine the potential risk factors for the development of radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinoma received external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB) in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations with different factors (age, time period, tumor stage) were analyzed with ${\chi}^2$ (chi-squared) and Fisher exact tests. We found that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiation cystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitis was significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P < 0.05; radiation cystitis: 2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progression compared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitis was not correlated with age or, time period following radiation, for each patient (P > 0.05). These observations indicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitis and cystitis in cervical carcinoma patients receiving radiotherapy.


  1. Combes PF, Daly NJ, Horiot JC, et al (1985). Results of radiotherapy alone in 581 patients with Stage II carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys, 11, 463-71.
  2. Esche BA, Crook JM, Horiot JC (1987). Dosimetric methods in the optimization of radiotherapy for carcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys, 13, 1183-92.
  3. Fujikawa K, Miyamoto T, Ihara Y, Matsui Y, Takeuchi H (2001). High incidence of severe urologic complications following radiotherapy for cervical cancer in Japanese women. Gynecol Oncol, 80, 21-3.
  4. Hanks GE, Herring DF, Kramer S (1983). Patterns of care outcome studies. Results of the national practice in cancer of the cervix. Cancer, 51, 959-67.<959::AID-CNCR2820510533>3.0.CO;2-K
  5. Herrmann T, Knorr A, Dorner K (1987). [The RTOG/EORTC classification criteria for early and late radiation reactions]. Radiobiol Radiother (Berl), 28, 519-28.
  6. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  7. Kapp KS, Stuecklschweiger GF, Kapp DS, et al (1997). Carcinoma of the cervix: analysis of complications after primary external beam radiation and Ir-192 HDR brachytherapy. Radiother Oncol, 42, 143-53.
  8. Kim HJ, Kim S, Ha SW, Wu HG (2008). Are doses to ICRU reference points valuable for predicting late rectal and bladder morbidity after definitive radiotherapy in uterine cervix cancer? Tumori, 94, 327-32.
  9. Lanciano RM, Martz K, Montana GS, Hanks GE (1992). Influence of age, prior abdominal surgery, fraction size, and dose on complications after radiation therapy for squamous cell cancer of the uterine cervix. A patterns of care study. Cancer, 69, 2124-30.<2124::AID-CNCR2820690819>3.0.CO;2-D
  10. Landoni F, Maneo A, Colombo A, et al (1997). Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet, 350, 535-40.
  11. Lei X, Qian CY, Qing Y, et al (2011). Californium-252 brachytherapy combined with external-beam radiotherapy for cervical cancer: long-term treatment results. Int J Radiat Oncol Biol Phys, 81, 1264-70.
  12. Mabuchi S, Ugaki H, Isohashi F, et al (2010). Concurrent weekly nedaplatin, external beam radiotherapy and high-dose-rate brachytherapy in patients with FIGO stage IIIb cervical cancer: a comparison with a cohort treated by radiotherapy alone. Gynecol Obstet Invest, 69, 224-32.
  13. Montana GS, Fowler WC (1989). Carcinoma of the cervix: analysis of bladder and rectal radiation dose and complications. Int J Radiat Oncol Biol Phys, 16, 95-100.
  14. Morris M, Eifel PJ, Lu J, et al (1999). Pelvic radiation with concurrent chemotherapy compared with pelvic and paraaortic radiation for high-risk cervical cancer. N Engl J Med, 340, 1137-43.
  15. Nakano T, Kato S, Ohno T, et al (2005). Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervix. Cancer, 103, 92-101.
  16. Niibe Y, Hayakawa K, Kanai, T, et al (2006). Optimal dose for stage IIIB adenocarcinoma of the uterine cervix on the basis of biological effective dose. Eur J Gynaecol Oncol, 27, 47-9.
  17. Niibe Y, Kenjo M, Onishi H, et al (2010). High-dose-rate intracavitary brachytherapy combined with external beam radiotherapy for stage IIIb adenocarcinoma of the uterine cervix in Japan: a multi-institutional study of Japanese Society of Therapeutic Radiology and Oncology 2006-2007 (study of JASTRO 2006-2007). Jpn J Clin Oncol, 40, 795-9.
  18. Palma DA, Verbakel WF, Otto K, Senan S (2010). New developments in arc radiation therapy: a review. Cancer Treat Rev, 36, 393-9.
  19. Pesee M, Krusun S, Padoongcharoen P (2010). High dose rate cobalt-60 afterloading intracavitary therapy of uterine cervical carcinomas in Srinagarind hospital - analysis of complications. Asian Pac J Cancer Prev, 11, 491-4.
  20. Rose PG, Bundy BN, Watkins EB, et al (1999). Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med, 340, 1144-53.
  21. Saibishkumar EP, Patel FD, Sharma SC (2006). Evaluation of late toxicities of patients with carcinoma of the cervix treated with radical radiotherapy: an audit from India. Clin Oncol (R Coll Radiol), 18, 30-7.
  22. Suzuki Y, Nakano T, Arai T, et al (2000). Progesterone receptor is a favorable prognostic factor of radiation therapy for adenocarcinoma of the uterine cervix. Int J Radiat Oncol Biol Phys, 47, 1229-34.
  23. Toita T, Takizawa Y, Nakano M, et al (1994). Radical radiation therapy for adenocarcinoma of the uterine cervix. Strahlenther Onkol, 170, 277-80.
  24. Uno T, Itami J, Aruga M, et al (1998). High dose rate brachytherapy for carcinoma of the cervix: risk factors for late rectal complications. Int J Radiat Oncol Biol Phys, 40, 615-21.
  25. Verellen D, De Ridder M, Linthout N, et al (2007). Innovations in image-guided radio therapy. Nat Rev Cancer, 7, 949-60.
  26. Waggoner SE (2003). Cervical cancer. Lancet, 361, 2217-25.
  27. Yu ZL, Suo ZM, Yan RM, et al (2004). Retrospective analysis on 240 cervical cancer patients treated with radiotherapy. Inner Mongolia Med J, 36, 786-788.

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