Chronic radiation proctitis: tricks to prevent and treat

Abstract

ObjectiveThe purpose of this study was to give an overview of the measures used to prevent chronic radiation proctitis (CRP) and to provide an algorithm for the treatment of CRP.MethodsMedical literature databases including PubMed and Medline were screened and critically analyzed for relevance in the scope of our purpose.ResultsCRP is a relatively frequent late side effect (5–20%) and mainly dependent on the dose and volume of irradiated rectum. Radiation treatment (RT) techniques to prevent CRP are constantly improving thanks to image-guided RT and intensity-modulated RT. Also, newer techniques like protons and new devices such as rectum spacers and balloons have been developed to spare rectal structures. Biopsies do not contribute to diagnosing CRP and should be avoided because of the risk of severe rectal wall damage, such as necrosis and fistulas. There is no consensus on the optimal treatment of CRP. A variety of possibilities is available and includes topical and oral agents, hyperbaric oxygen therapy, and endoscopic interventions.ConclusionsCRP has a natural history of improving over time, even without treatment. This is important to take into account when considering these treatments: first be conservative (topical and oral agents) and be aware that invasive treatments can be very toxic.

Pelvic Catastrophe after Elastic Band Ligation in an Irradiated Rectum

“…It affects 5-20% of patients treated with radiation [5] . The most typical clinical presentation is rectal bleeding, but functional symptoms such as urgency, tenesmus, pain, incontinence, and mucous discharge can be present.…”

“…Due to the risks of manipulating irradiated mucosa, the unpredictability of complicated disease, and the poor functional outcomes after deep ulceration or fistulisation, treatment of radiation proctopathy should, whenever possible, rely on conservative measures, as suggested in an algorithm by Vanneste et al [5] . Rectal biopsies are not helpful in its management and can only be justified if the suspicion of malignancy is high.…”

“…However, a safe rectal radiation dose cutoff is difficult to establish as most studies find marked rectal radiation dose overlap between symptomatic and asymptomatic patients, and some patients with exceedingly high rectal doses develop no complications [6][7][8] , suggesting individual susceptibility factors. Some patient characteristics that have been associated with increased risk of late radiation toxicity include vascular disease, diabetes, connective tissue disease, inflammatory bowel disease, HIV infection, smoking, and genetic variations [5] .…”

Expression of vascular endothelial growth factor and its correlation with clinical symptoms and endoscopic findings in patients with chronic radiation proctitis

“…ChRP is a troublesome complication in patients who undergo radiotherapy for pelvic malignancies. The incidence rate of ChRP varies from 2% to 20% in patients treated for prostate or gynaecological malignant tumours [5][6][7][8][9][10][11][12].…”

Prostate Cancer Radiation Therapy: What Do Clinicians Have to Know?

“…Dose escalation in prostate EBRT leads to improved locoregional control, biochemical disease-free survival (bDFS), distant metastasis-free survival, PC specific mortality, and even overall survival in intermediate- and high-risk PC [5–11]. However, dose escalation is limited by toxicity of surrounding healthy tissues, and therefore improved tumour control is expected to come at the cost of higher toxicity, greatly impacting patients' quality of life [12–14]. However, dose escalation is possible due to advances in different RT techniques, sophisticated computer-based treatment planning, and/or development of extra devices, avoiding increased dose delivery to the surrounding healthy tissue.…”