Inflammatory bowel disease-associated malignancies and considerations for radiation impacting bowel: a scoping review

Abstract

Background: Inflammatory bowel disease (IBD), subdivided into Crohn's disease (CD) and ulcerative colitis (UC), is an auto-inflammatory gastrointestinal condition with an established increased risk of certain malignancies. Compared to sporadic cancers in the general population, IBD-associated malignancies present unique challenges to providing quality care. Radiation therapy (RT) targeting IBD-associated malignancies may directly impact inflamed bowel, with special considerations for the risk of toxicities. Historically, patients with IBD have been less likely to receive radiotherapy in proximity to bowel due to a poor understanding of the potential for acute and chronic toxicities and unclear treatment outcomes. We present a scoping review, to more fully assess IBD-associated malignancies and their treatment. As opposed to a systematic review, this approach allows us to analyze the broadest range of literature, including experimental and non-experimental research, and reflect on current guidelines and practices.Methods: Literature search: a systematic, scoping search of published literature was conducted using applicable PRISMA scoping review (ScR) guidelines. The literature search was conducted on PubMed and was searched systematically by screening all publications from January 1990 to June 2021. Citations from the included articles were also manually searched. Relevant National Comprehensive Cancer Network guidelines were reviewed. Final query was December 2021 in editing. Articles were selected for full text reading if the abstract reported on malignancy in IBD or bowel toxicities. Results:The pelvic malignancies found in the IBD patient population, including colorectal carcinoma, anal carcinoma, lymphoma, small bowel adenocarcinoma (SBA), and prostate cancer (PCa) are outlined in this scoping review. Additional cancers that have a contested relationship with IBD, including cervical, bladder, and upper GI cancers, are also explored. This review provides literature guided recommendations on the eligibility of patients with IBD to receive RT, management of IBD during and after treatment, and counseling for radiation-induced toxicities.Conclusions: After review of the literature, IBD should not be considered an absolute contraindication to radiation therapy, given the lack of evidence for increased toxicities, and the evolution of RT techniques which limit radiation dose to the bowel.

Inflammatory Bowel Disease Treatment in Cancer Patients—A Comprehensive Review

“…However, a retrospective study from Mount Sinai Hospital reported an unaltered 5-year survival rate of IBD patients with rectal cancer treated with radiation therapy and no increased gastrointestinal toxicity [ 70 ]. Besides that, a systematic review showed its safety for use on IBD patients, with acceptable toxicity profiles, with a similar occurrence of flares between patients treated with radiotherapy or surgery [ 71 ], supporting that IBD should not be considered a contraindication for radiation, as reviewed by Bodofsky et al [ 72 ].…”

The Optimal Management of Inflammatory Bowel Disease in Patients with Cancer

“…There are some concerns about the toxicity of radiotherapy for cancer in patients with IBD. Thus, many oncologists prefer to avoid pelvic radiotherapy in cases of IBD [ 115 ]. In a retrospective study of 100 IBD patients with prostate cancer, 47% received radiation therapy.…”

Monitoring Patients With Inflammatory Bowel Disease at High Risk of Anal Cancer

“…The potential for IBD flares during treatment further complicates anal cancer management for radiation oncologists. Despite these considerations, IBD is not considered an absolute contraindication to radiation therapy (29). Finally, providers must also balance the risk of IBD disease exacerbation when advanced therapies are withdrawn for cancer treatments with the risks of continuing therapy while treatment for cancer is ongoing (22).…”