Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

Annède, Pierre; Seisen, Thomas; Klotz, C.; Mazeron, R.; Maroun, Pierre; Petit, Claire; Deutsch, Éric; Bossi, Alberto; Haie-Méder, Christine; Chargari, Cyrus; Blanchard, Pierre

doi:10.21037/jgo.2017.01.13

Cited by 17 publications

(18 citation statements)

References 19 publications

(25 reference statements)

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“…Two previously published cohorts displayed high rates of IBD activity after abdominal or pelvic irradiation. Among 28 IBD patients coming from a singlecentre experience who were irradiated from 1989 to 2015, for prostate, rectum or cervix cancer, half of them experienced an IBD flare within the first 6 months 15 . In another multicentre cohort of 47 IBD patients irradiated for prostate cancer, rate of IBD flare was double than that in IBD patients with cancers treated without radiotherapy 16 with highest risk within the first 6 months after radiotherapy.…”

Section: Discussionmentioning

confidence: 98%

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Impact of abdominal or pelvic radiotherapy on disease activity in inflammatory bowel disease: a multicentre cohort study from the GETAID

Broussard¹,

Rivière²,

Bonnet³

et al. 2020

Aliment Pharmacol Ther

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SummaryBackgroundAbdominal or pelvic radiotherapy in inflammatory bowel disease (IBD) patients raises concerns regarding the risk of worsening of underlying disease.AimTo assess the impact of radiotherapy on IBD course.MethodsA retrospective multicentre study including IBD patients exposed to abdominal or pelvic irradiation was conducted, retrieving IBD activity by semester (6‐month periods) before (from S‐4 to S‐1) and after (from S + 1 to S + 6) radiotherapy and IBD flare during follow‐up.ResultsSixty‐one patients (32 women, mean age 59 years), with 467 patient semesters of follow‐up, treated for digestive (n = 31), urinary tract (n = 23) and gynaecological cancers (n = 7) were included. Rates of IBD activity per semester were, respectively, 21% (95% CI: 16‐27) from S‐4 to S‐1; 12% (7‐19) from S + 1 to S + 3 (P = 0.15 vs S‐4 to S‐1) and 16% (10‐25) from S + 4 to S + 6 (P = 0.45 vs S‐4 to S‐1). With a median follow‐up of 156 weeks (interquartile range: 82‐365), rates of survival without IBD flare at 1 and 3 years after radiotherapy were 82.5% (73.2‐93.0) and 70.6% (58.8‐84.7). Moderate‐to‐severe acute radiotherapy‐induced gut toxicity and the absence of concomitant chemotherapy were independently associated with an increased risk of flare.ConclusionMost patients with non‐active IBD can be safely treated with abdominal or pelvic radiotherapy. Patients having acute gut toxicity and those without concomitant chemotherapy should be more closely monitored in the post‐radiotherapy period.

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Section: Discussionmentioning

confidence: 98%

“…Indeed, few data are available so far on short and long‐term safety of radiotherapy in patients with IBD. Two recent studies suggested a high rate of disease flare after abdominal or pelvic radiotherapy in IBD patients; but these results are hampered by small numbers and lack of evaluation of disease activity before radiotherapy 15,16 …”

Section: Introductionmentioning

confidence: 99%

Impact of abdominal or pelvic radiotherapy on disease activity in inflammatory bowel disease: a multicentre cohort study from the GETAID

Broussard¹,

Rivière²,

Bonnet³

et al. 2020

Aliment Pharmacol Ther

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Section: Discussionmentioning

confidence: 99%

“…Many studies have attempted to assess the safety of RT in patients with IBD [ 5 , 7 , 8 , 11 ]. An examination of the correlation between pelvic RT and IBD patients showed that only the patients with a rectal IBD location or a low body mass index had experienced more severe IBD activity within or after 6 months following the RT [ 11 ]. A study assessing IBD-specific outcomes in 100 veterans with IBD revealed that the rates of IBD-associated hospitalizations and IBD-related surgeries were not significantly different between those treated with or without radiation, and there was no effect of radiation on longer-term outcomes [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Ulcerative colitis that developed during radiotherapy for prostate cancer, deteriorated rapidly and required emergency surgery

et al. 2020

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Background Although there are reports linking ulcerative colitis (UC) to prostate cancer (PC), those reports are of PC patients who were previously diagnosed with UC. There are no reports of the development of UC during radiotherapy. Here we describe the first case of a patient who developed UC during radiotherapy for PC. The UC progressed rapidly and required emergency surgery. Case presentation A 61-year-old Japanese man underwent a prostate biopsy at another hospital due to a high prostate-specific antigen level and was diagnosed with PC. Goserelin and bicalutamide treatment was initiated in 2019, and intensity-modulated radiotherapy (total of 60 Gy/20 Fr) was administered in 2020. Diarrhea began during the radiotherapy and bleeding began post-radiotherapy. He was admitted to another hospital 14 days after the end of the radiotherapy, and colonoscopy revealed a deep ulcer in the colon, which led to the suspicion of UC. He was transferred to our hospital, and colonoscopy showed a widespread map-like ulcer, pseudopolyposis, and very easy bleeding in the colon. We diagnosed severe UC, and it worsened rapidly with uncontrollable bleeding, which we considered an indication for surgery. Emergency surgery (a total colectomy and ileostomy creation) was performed. The specimens confirmed an extensively spreading ulcer throughout the colon. The pathological report was UC in the active phase. The postoperative course was good. Conclusions When a patient exhibits diarrhea while undergoing radiotherapy for PC, clinicians should be aware of the possibility of UC in addition to radiation colitis, and colonoscopy should be considered.

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“…Furthermore, acute GI toxicity of grade 2 or higher is exacerbated in patients undergoing concomitant medical therapy for IBD [7]. Advances in modern RT have demonstrated a trend toward improved toxicity profiles from treatment in high-risk groups such as patients with IBD [8,9].…”

Section: Purposementioning

confidence: 99%

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis

Träger¹,

Greenberger²,

Harrison³

et al. 2018

jcb

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High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor.SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure.The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate – V100% = 97.3%, V150% = 35%, V200% = 14.5%; Urethra – V118% = 0%; Rectum – D2 cc = 51.6%, V75% = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time.SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy.

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Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

Cited by 17 publications

References 19 publications

Impact of abdominal or pelvic radiotherapy on disease activity in inflammatory bowel disease: a multicentre cohort study from the GETAID

Impact of abdominal or pelvic radiotherapy on disease activity in inflammatory bowel disease: a multicentre cohort study from the GETAID

Ulcerative colitis that developed during radiotherapy for prostate cancer, deteriorated rapidly and required emergency surgery

SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis

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