Acute anal toxicity after whole pelvic radiotherapy in patients with asymptomatic haemorrhoids: identification of dosimetric and patient factors

Abstract

Objective: Patients with asymptomatic haemorrhoids are known to be less tolerant of radiation doses lower than known tolerance doses. In the present study, the authors sought to identify the risk factors of acute haemorrhoid aggravation after whole pelvic radiotherapy (WPRT). Methods: The records of 33 patients with cervical, rectal or prostate cancer with asymptomatic haemorrhoids, which were confirmed by colonoscopy before the start of radiotherapy (RT), were reviewed. Acute anal symptoms, such as anal pain and bleeding, were observed up to 1 month after RT completion. Dosimetric and patient factors were analysed, and subgroup analyses were performed.Results: The median induction dose for acute anal symptoms was 34.1 Gy (range, 28.8-50.4 Gy). Postoperative treatment intent showed more acute anal toxicity of patient factors (p 5 0.04). In subgroup analysis, post-operative treatment intent and concurrent chemoradiotherapy were found to be related to acute anal symptoms (p , 0.01). Of the dosimetric factors, V 10

Dose-volume analysis of predictors for acute anal toxicity after radiotherapy in prostate cancer patients

“…Similar results were also observed in validation cohort, in which AAT developed in 44.2% of the patients with hemorrhoids, but only in 17.0% of the patients without hemorrhoids. Our results also confirm the high frequency of AAT (42.4–50%) after whole pelvic irradiation of 45–50.4 Gy for pelvic malignant disease reported previously in Korean patients with asymptomatic hemorrhoids [11, 12]. Interestingly, few studies from America and Europe have addressed this topic, mainly because both hemorrhoids and AAT are less common in patients in these regions, and the symptoms are usually mild and resolve spontaneously [5, 17, 18].…”

“…The median induction dose for AAT is about 37.5 Gy (38.3 Gy calculated as EQD2) in our study, which is similar to the results of the two studies from Korea (34.1–36.9 Gy) [11, 12]. However, none of the DVH parameters were significant predictors of AAT in their studies, and only V10 or V30 and V40 showed marginal correlations with AAT [11, 12]. Indeed, it is difficult to draw reliable conclusions from two studies with such small sample sizes of 31 and 33 patients, and DVH predictors of AAT should be re-evaluated in larger patient cohorts.…”

“…Although radiation doses of 45 to 55 Gy in fractions of 1.8 to 2 Gy are considered to be safe for the anal canal [22], patients with hemorrhoids may be troubled even by low radiation doses. The median induction dose for AAT is about 37.5 Gy (38.3 Gy calculated as EQD2) in our study, which is similar to the results of the two studies from Korea (34.1–36.9 Gy) [11, 12]. However, none of the DVH parameters were significant predictors of AAT in their studies, and only V10 or V30 and V40 showed marginal correlations with AAT [11, 12].…”

“…However, anal pain and bleeding are quite common symptoms during pelvic radiotherapy for Asian patients. Two studies from Korea indicated that hemorrhoids are an important risk factor for AAT in patients undergoing pelvic radiotherapy [11, 12]. However, both studies only enrolled small numbers of patients (31 and 33 patients, respectively) and included cases with different cancers and different radiation techniques, which made these data inadequate for reliable dosimetric analysis.…”

Dosimetric planning study for the prevention of anal complications after post-operative whole pelvic radiotherapy in cervical cancer patients with hemorrhoids

“…Our study was focused on the acute anal complication in patients with haemorrhoids, and the published study 11 about acute anal toxicity is rare. A previous study 29 demonstrated that 34.1 Gy is the induction dose of acute anal symptoms in patients with haemorrhoids, and we conservatively chose the dose objective of the anal canal. To apply IM-WPRT plan in the clinical field, the accurate target delineation and the proper dose constraint of the anal canal is a requisite.…”