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

Abstract

Objective: Radiation-induced anal toxicity can be induced by low radiation doses in patients with haemorrhoids. The object of this study was to determine the dosimetric benefits of different whole pelvic radiotherapy (WPRT) techniques in terms of dose delivered to the anal canal in post-operative patients with cervical cancer. Methods: The planning CT images of 10 patients with cervical cancer undergoing postoperative radiotherapy were used for comparison of three different plans. All patients had been treated using the conventional box technique WPRT (CV-WPRT), and we tried low-marginmodified WPRT (LM-WPRT), three-dimensional conformal techniques WPRT (CF-WPRT) and intensity-modulated WPRT (IM-WPRT) planning for dosimetric comparison of the anal canal, retrospectively. Results: Mean anal canal doses of the IM-WPRT were significantly lower (p , 0.05) than those of CV-WPRT, LM-WPRT and CF-WPRT, and V 10 , V 20 , V 30 and V 40 to the anal canal were also significantly lower for IM-WPRT (p , 0.05). The proportion of planning target volumes (PTVs) that received $98% of the prescribed dose for all plans was .99%, and the proportion that received $108% of the prescribed dose for IM-WPRT was ,2%. Volumes of bladders and rectums that received $30 or $40 Gy were significantly lower for IM-WPRT than for three of the four-field WPRT plans (p 5 0

Aggravation of Hemorrhoids in Patients With Cervical Cancer Undergoing Radiotherapy: A Nationwide Population-based Study

“…The anorectal side-effects of pelvic irradiation are classified as radiation-induced proctitis (10), and the effect of irradiation on hemorrhoids is often neglected. As a result, few studies have addressed the relationship between RT and hemorrhoids (5,8,9). The symptoms of acute proctitis are diarrhea and tenesmus and those of chronic proctitis are bleeding and painful defecation (10).…”

“…However, in patients with hemorrhoids, since the outer wall of the anal canal is weak, there is a possibility that hemorrhoids may worsen at lower doses (5,6). Furthermore, only a small number of studies have examined the relationship between hemorrhoid aggravation and RT dose (5,8,9). However, the risk of aggravation increases further when internal hemorrhoids are considered, and patients with asymptomatic hemorrhoids are likely to develop symptomatic hemorrhoids after RT.…”

HYPHYCA: a prospective study in 613 patients conducting a comprehensive analysis for predictive factors of physiological 18F-FDG anal uptake

“…Indeed, in our study, stratification according to the time interval of the last hemorrhoidal surge was not necessary to obtain statistical significance. This antecedent should be systematically sought before any post-treatment PET evaluation of anal cancer, especially as it is the most frequently encountered affection in proctology [15] and as radiotherapy is a known provider of hemorrhoidal crisis [16].…”