Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Endoscopic findings of rectal mucosal damage after pelvic radiotherapy for cervical carcinoma: correlation of rectal mucosal damage with radiation dose and clinical symptoms

  • Kim, Tae Gyu (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2013.02.19
  • Accepted : 2013.05.05
  • Published : 2013.06.30
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Abstract

Purpose: To describe chronic rectal mucosal damage after pelvic radiotherapy (RT) for cervical cancer and correlate these findings with clinical symptoms and radiation dose. Materials and Methods: Thirty-two patients who underwent pelvic RT were diagnosed with radiation-induced proctitis based on endoscopy findings. The median follow-up period was 35 months after external beam radiotherapy (EBRT) and intracavitary radiotherapy (ICR). The Vienna Rectoscopy Score (VRS) was used to describe the endoscopic findings and compared to the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) morbidity score and the dosimetric parameters of RT (the ratio of rectal dose calculated at the rectal point [RP] to the prescribed dose, biologically effective dose [BED] at the RP in the ICR and EBRT plans, ${\alpha}/{\beta}$ = 3). Results: Rectal symptoms were noted in 28 patients (rectal bleeding in 21 patients, bowel habit changes in 6, mucosal stools in 1), and 4 patients had no symptoms. Endoscopic findings included telangiectasia in 18 patients, congested mucosa in 20, ulceration in 5, and stricture in 1. The RP ratio, $BED_{ICR}$, $BED_{ICR+EBRT}$ was significantly associated with the VRS (RP ratio, median 76.5%; $BED_{ICR}$, median 37.1 $Gy_3$; $BED_{ICR+EBRT}$, median 102.5 $Gy_3$; p < 0.001). The VRS was significantly associated with the EORTC/RTOG score (p = 0.038). Conclusion: The most prevalent endoscopic findings of RT-induced proctitis were telangiectasia and congested mucosa. The VRS was significantly associated with the EORTC/RTOG score and RP radiation dose.

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References

  1. Leiper K, Morris AI. Treatment of radiation proctitis. Clin Oncol (R Coll Radiol) 2007;19:724-9. https://doi.org/10.1016/j.clon.2007.07.008
  2. Halkett G, Aoun S, Hayne D, et al. EORTC radiation proctitisspecific quality of life module: pretesting in four European countries. Radiother Oncol 2010;97:294-300. https://doi.org/10.1016/j.radonc.2010.04.001
  3. Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R. Endoscopic scoring of late rectal mucosal damage after conformal radiotherapy for prostatic carcinoma. Radiother Oncol 2000;54:11-9. https://doi.org/10.1016/S0167-8140(99)00173-5
  4. Goldner G, Tomicek B, Becker G, et al. Proctitis after externalbeam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity: results of a prospective multicenter study of 166 patients. Int J Radiat Oncol Biol Phys 2007;67:78-83. https://doi.org/10.1016/j.ijrobp.2006.08.055
  5. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-6. https://doi.org/10.1016/0360-3016(95)00060-C
  6. Trotti A, Byhardt R, Stetz J, et al. Common toxicity criteria: version 2.0. an improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 2000;47:13-47. https://doi.org/10.1016/S0360-3016(99)00559-3
  7. Kennedy GD, Heise CP. Radiation colitis and proctitis. Clin Colon Rectal Surg 2007;20:64-72. https://doi.org/10.1055/s-2007-970202
  8. Hayne D, Vaizey CJ, Boulos PB. Anorectal injury following pelvic radiotherapy. Br J Surg 2001;88:1037-48. https://doi.org/10.1046/j.0007-1323.2001.01809.x
  9. Nussbaum ML, Campana TJ, Weese JL. Radiation-induced intestinal injury. Clin Plast Surg 1993;20:573-80.
  10. Shin KH, Huh SJ, Chie EK, et al. Analysis of correlation between rectal complications and rectal dose following high dose rate intracavitary radiotherapy in patients with uterine cervix cancer: in vivo dosimetric analysis. Radiat Med 1999;17:289-93.
  11. Hu K, Wallner K. Clinical course of rectal bleeding following I-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys 1998;41:263-5. https://doi.org/10.1016/S0360-3016(98)00080-7
  12. Kochhar R, Patel F, Dhar A, et al. Radiation-induced proctosigmoiditis: prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci 1991;36:103-7. https://doi.org/10.1007/BF01300096
  13. Zimmerer T, Bocker U, Wenz F, Singer MV. Medical prevention and treatment of acute and chronic radiation induced enteritis: is there any proven therapy? a short review. Z Gastroenterol 2008;46:441-8. https://doi.org/10.1055/s-2008-1027150
  14. Theis VS, Sripadam R, Ramani V, Lal S. Chronic radiation enteritis. Clin Oncol (R Coll Radiol) 2010;22:70-83. https://doi.org/10.1016/j.clon.2009.10.003
  15. Rustagi T, Mashimo H. Endoscopic management of chronic radiation proctitis. World J Gastroenterol 2011;17:4554-62. https://doi.org/10.3748/wjg.v17.i41.4554
  16. Goldner G, Potter R, Kranz A, Bluhm A, Dorr W. Healing of late endoscopic changes in the rectum between 12 and 65 months after external beam radiotherapy. Strahlenther Onkol 2011;187:202-5. https://doi.org/10.1007/s00066-010-2211-5
  17. Hovdenak N, Fajardo LF, Hauer-Jensen M. Acute radiation proctitis: a sequential clinicopathologic study during pelvic radiotherapy. Int J Radiat Oncol Biol Phys 2000;48:1111-7. https://doi.org/10.1016/S0360-3016(00)00744-6
  18. O'Brien PC, Hamilton CS, Denham JW, Gourlay R, Franklin CI. Spontaneous improvement in late rectal mucosal changes after radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2004;58:75-80. https://doi.org/10.1016/S0360-3016(03)01445-7
  19. Moore EM, Magrino TJ, Johnstone PA. Rectal bleeding after radiation therapy for prostate cancer: endoscopic evaluation. Radiology 2000;217:215-8. https://doi.org/10.1148/radiology.217.1.r00oc24215
  20. Andreyev HJ, Vlavianos P, Blake P, Dearnaley D, Norman AR, Tait D. Gastrointestinal symptoms after pelvic radiotherapy: role for the gastroenterologist? Int J Radiat Oncol Biol Phys 2005;62:1464-71. https://doi.org/10.1016/j.ijrobp.2004.12.087
  21. Georg P, Kirisits C, Goldner G, et al. Correlation of dosevolume parameters, endoscopic and clinical rectal side effects in cervix cancer patients treated with definitive radiotherapy including MRI-based brachytherapy. Radiother Oncol 2009;91:173-80. https://doi.org/10.1016/j.radonc.2009.01.006
  22. Denham JW, O'Brien PC, Dunstan RH, et al. Is there more than one late radiation proctitis syndrome? Radiother Oncol 1999;51:43-53. https://doi.org/10.1016/S0167-8140(99)00027-4
  23. Schultheiss TE, Lee WR, Hunt MA, Hanlon AL, Peter RS, Hanks GE. Late GI and GU complications in the treatment of prostate cancer. Int J Radiat Oncol Biol Phys 1997;37:3-11. https://doi.org/10.1016/S0360-3016(96)00468-3
  24. Huh SJ, Lim DH, Ahn YC, et al. Comparison between in vivo dosimetry and barium contrast technique for prediction of rectal complications in high-dose-rate intracavitary radiotherapy in cervix cancer patients. Strahlenther Onkol 2003;179:191-6. https://doi.org/10.1007/s00066-003-1015-2
  25. Hyun Kim T, Choi J, Park SY, et al. Dosimetric parameters that predict late rectal complications after curative radiotherapy in patients with uterine cervical carcinoma. Cancer 2005;104:1304-11. https://doi.org/10.1002/cncr.21292
  26. Dearnaley DP, Khoo VS, Norman AR, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. Lancet 1999;353:267-72. https://doi.org/10.1016/S0140-6736(98)05180-0
  27. Miller AR, Martenson JA, Nelson H, et al. The incidence and clinical consequences of treatment-related bowel injury. Int J Radiat Oncol Biol Phys 1999;43:817-25. https://doi.org/10.1016/S0360-3016(98)00485-4
  28. Portelance L, Chao KS, Grigsby PW, Bennet H, Low D. Intensitymodulated radiation therapy (IMRT) reduces small bowel, rectum, and bladder doses in patients with cervical cancer receiving pelvic and para-aortic irradiation. Int J Radiat Oncol Biol Phys 2001;51:261-6.
  29. Perez CA, Fox S, Lockett MA, et al. Impact of dose in outcome of irradiation alone in carcinoma of the uterine cervix: analysis of two different methods. Int J Radiat Oncol Biol Phys 1991;21:885-98. https://doi.org/10.1016/0360-3016(91)90726-K
  30. Clark BG, Souhami L, Roman TN, Chappell R, Evans MD, Fowler JF. The prediction of late rectal complications in patients treated with high dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys 1997;38:989-93. https://doi.org/10.1016/S0360-3016(97)00074-6
  31. Cheng JC, Peng LC, Chen YH, Huang DY, Wu JK, Jian JJ. Unique role of proximal rectal dose in late rectal complications for patients with cervical cancer undergoing high-dose-rate intracavitary brachytherapy. Int J Radiat Oncol Biol Phys 2003;57:1010-8. https://doi.org/10.1016/S0360-3016(03)00721-1
  32. Wachter S, Gerstner N, Goldner G, Potzi R, Wambersie A, Potter R. Rectal sequelae after conformal radiotherapy of prostate cancer: dose-volume histograms as predictive factors. Radiother Oncol 2001;59:65-70. https://doi.org/10.1016/S0167-8140(01)00281-X
  33. Koom WS, Sohn DK, Kim JY, et al. Computed tomographybased high-dose-rate intracavitary brachytherapy for uterine cervical cancer: preliminary demonstration of correlation between dose-volume parameters and rectal mucosal changes observed by flexible sigmoidoscopy. Int J Radiat Oncol Biol Phys 2007;68:1446-54. https://doi.org/10.1016/j.ijrobp.2007.02.009

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